用“香蕉”胃术治疗高位小弯胃癌60例临床研究

CLINICAL RESEARCH ON BANANA SHAPED GASTRIC OPERATION IN TREATING GASTRIC CARCINOMA OF HIGH- POSITIONED LESSER CURVATURE

目的 采用“香蕉”胃术治疗高位小弯胃癌,既能做到切线无癌细胞残留,确保根治,又能同时避免难度大、并发症多的全胃切除等复杂术式。方法 选择高位小弯胃癌且无远处转移患者,先行胃周围淋巴结清扫及韧带分离,然后在癌肿近端4.0cm处取数块组织,行快速冰冻病理活检,对发现癌细胞者,则按“香蕉”胃术的弧形设计,上移切线处,再取活检,如活检阴性,可于平脾下极处胃体置两把kocher氏钳,夹胃宽度4.0cm,从两钳间切断后,沿胃纵轴向近端呈弧形行边切边缝法断离,直至小弯侧,使大弯侧胃体形成“香蕉”形残胃。结果 “香蕉”胃术式(新法)切线残留癌发生率为14.36％,旧法切线残留癌发生率为78.6％,两者比较,有显著性差异(u=2.378,P<0.01)。对42例患者分别进行了3年、5年生存率随访,其疗效优于常规术式。结论 “香蕉”胃术式治疗高位小弯胃癌,符合肿瘤根治原则,切线癌细胞残留率低,多能保留胃体组织,大部分病人不用行近侧胃切除或全胃切除。该术式具有操作简单、创伤小、并发症少等优点。

Objective To obtain radical cure by banana - shaped gastric operation without leaving cancer cells in the tangential position and to avoid complex operations such as total gastrectomy in treating gastric carcinoma of high - positioned lesser curvature. Methods To treat gastric carcinoma of high - positioned lesser curvature, lymph nodes were cleared and syndesmodiastasis were made around the stomach. Then some tissues were taken out 4cm from the proximal end of tumor and received rapid freezing and pathological biopsy. If cancer cells were detected, banana - shaped operation was performed to take them out by moving the tangential position upward and then they underwent biopsy. If the tissues were found to be negative, two pairs of Kocher's forceps were placed in the extreme end of the stomach under the plane spleen. After the clamped part of the stomach, about 4.0 wide, was cut off and the cutting and suture were performed simultaneously in arch toward the proximal end along the gastric longitudinal axis up to the lesser curvature to form a banana - shaped residual stomach in the side of greater curvature. Results The incidence rates of residual cancer in the tangential position after the banana - shaped operation and the routine one were 14.36% and 78. 6%. There existed significant difference between the two therapies( u = 2. 378, P < 0.01). The 3 - year and 5- year follow - up surveys showed that better therapeutic effects were got by the new method than by the routine one in terms of survival rate. Conclusion Banana - shaped operation in treating gastric carcinoma of high - positioned lesser curvature conforms to the principle of radical operation. The residual rate of cancer cells in the tangential position is low and can mostly preserve gastric tissues. Most patients do not need undergo gastrectomy. This kind of operation has proved to be simple and to induce little trauma and complications.