不切膈肌游离胃在手术治疗食管癌中的应用

The method of freeing stomach without incising diaphragm in surgical treatment for esophageal cancer

目的介绍不切膈肌游离胃在手术治疗食管癌中的应用及优点。方法在168例食管癌病人的手术治疗中均采用左胸入路,切开纵隔胸膜,吊起胸下段食管,切开贲门周围胸膜及腹膜反折,提出贲门,依次切开胃脾、肝胃、胃结肠、胃胰韧带及胃大弯网膜,清扫胃周淋巴结。结果165例顺利完成手术,2例因脾门组织出血打开3cm膈肌止血,1例因幽门淋巴结肿大打开3cm膈肌清扫淋巴结。术后病人呼吸平稳,咳痰有力,返流性食管炎减少,无胸胃潴留、膈肌裂孔疝发生。缩短住院时间, 减少住院费用。结论该术式避免切断膈神经分支,保留膈肌完整性,降低手术对病人呼吸功能的影响,减少术后并发症的发生,术后近期效果满意,生活质量提高。是一种值得推广的手术技术。

Objective To introduce the application and advantages of the method of freeing stomach without incising diaphragm in surgical treatment for esophageal cancer. Methods Operations on all the 168 patients with esophageal cancer followed the same procedure: mediastinal pleura was incised through left thoracic cavity; the lower third thoracic esophagus was picked up; pleura around cardia and peritoneal reflexum were incised; cardia was picked out; gastrolienal, gastrohepatic, gastrocolic, and gastropancreatic ligaments and omentum of greater curvature were incised in turn; clearance of gastric lymph nodes was performed. Results 165 of the operations were carried out successfully. Hemorrhage of hilum splenicum in 2 cases resulted in a 3 - centimeter incision in diaphragm. Pyloric lymphnode intumescence in 1 case resulted in clearance of lymph nodes through a 3 - centimeter incision in diaphragm. After operation, the patients recovered well, cases of reflux esophagitis were reduced, and no thoracic or gastric retention or diaphragma hia-tal hernia occurred. Both hospitalized days and medical cost were reduced. Conclusion This method can avoid breaking phrenic nerve, reduce the influence of operation on respiratory function of the patients and the occurrence of postoperative complication, keep the integrity of diaphragm, and achieve satisfactory short-term postoperative effects. Therefore, this method should be advocated.