胃底贲门癌手术入路的探讨

Surgical approach for carcinoma in the gastric cardia

目的探讨胃底贲门癌手术入路的最佳方法.方法将157例胃底贲门癌患者按手术入路分为经腹组(57例)和经胸组(100例),对比两组疗效.结果经腹组平均术中输血(164.91±36.83)m1,手术时间(219.04±10.72)min,住院时间(14.39±1.39)d,淋巴结清除数(6.04±2.84)个,未出现胸腔积液并发症,随访期间(3～60月)复发率22.80%;经胸组平均术中输血(575.50±40.12)ml、手术时间(286.40±7.94)min、住院时间(20.32±0.81)d,淋巴结清除数(3.62±2.56个),术后并发左侧胸腔积液15例,随访期间复发率41.00%,两组疗效有统计学差异.结论与经胸入路手术相比,胃底贲门癌经腹手术平均术中输血少、手术和住院时间短、淋巴结清除率高、肺部并发症少、术后复发率低,具有较好的临床疗效.

Objective To explore the optimal surgical approach for carcinoma in the gastric cardia. Methods A total of 157 patients with carcinoma in the gastric cardia were assigned into 2 groups according to the surgical approaches adopted , namely transabdominal (57 patients) and transthoracic approachs (100 patients), and the therapeutic effects of the two approaches were compared. Results In the transabdominal group, the average volume of intraoperative blood transfusion was 164.91±36.83 ml, average operative time 219.04±10.72 min and average hospital stay 14.39±1.39 d, with an average number of 6.04±2.84 lymph nodes removed. In the transthoracic group, the 4 parameters were 575.50±40.12 ml, 286.40±7.94 min, 20.32±0.81 d, and 3.62±2.56 respectively. None of the cases developed pleural effusion in the former group, which had a tumor recurrence rate of 22.80% within the follow-up period for 3 to 60 months. In contrast, 15 cases had pleural effusion in the latter group with a tumor recurrence rate of 41.00%. There was a significant difference between the two groups in terms of the therapeutic effects. Conclusion Transabdominal approach is the better alternative to transthoracic one for operation of carcinoma in the gastric cardia.