经腹全胃切除治疗胃癌170例临床分析

Clinical analysis transabdominal incision total gastrctomy for gastric carcinoma in 170 cases

目的 探讨胃癌患者行全胃切除的适应证 ,合理手术入路的选择及术后消化道的重建方式。方法 复习经腹全胃切除术的 170例胃癌患者的临床资料。结果 根治性全胃切除 13 2例 ,姑息性全胃切除 3 8例 ,联合脏器切除 18例。全胃切除后采用食管空肠Roux Y吻合重建消化道 110例 ,间置空肠法重建消化道 60例。食管空肠Roux Y吻合发生倾倒综合征 2 0例 ,返流性食管炎 6例 ,间置空肠法重建消化道无一例发生。结论 (1)胃癌尤其是胃底贲门癌采用经腹手术效果较好。 (2 )严格掌握手术适应证 ,采用全胃切除可提高胃癌患者的生存期及生存质量。 (3 )根治性全胃切除术后采用间置空肠重建消化道优于食管空肠Roux

Objective To investigate the indications and suitable surgical operation routes of total gastrectomy for gastric carcinoma and the reconstruction procedure of digestive tract following total gastrectomy.Methods The clinical data of total gastrectomy by abdominal incision in 170 patients with GC from 1991 to 2001 were reviewed.Results Radical total gastrectomy was prfomed in 132 cases,palliative total gastrectomy in 38 cases,total gastrectomy with combined re section of other organs in 18 cases,Roux en Y esophagojejunostomy in 110 cases following total gastrectomy.Interposition with jejunum in 60 cases following total gastrectomy.There are 20 cases with dumping syndrome and 6 cases with reflux esophagitis occurring in Roux en Y esophagojejunostomy,but none of cases occurs in those by interposition with jejunum.Conclusions (1)Transabdominal incision is the better choice for patients of GC,especially gastrocardiac carcinoma.(2)The total gastrectomy can raise the survival rate and quality of life of patients with GC,if the indications are stricted.(3)Interposition with jejunum following total gastrectomy is superior to Roux en Y esophagojejunostomy.