残胃胸内移植治疗胃大部切除术后食管、贲门癌(附26例报告)

Surgical treatment of esophageal and cardiac carcinoma following subtotal gastrectomy via intrathoracic transplantation of gastric remnant

目的 探讨胃大部切除术后食管、贲门癌 2 6例的外科治疗方法和效果。方法 2 6例均采用经左胸后外侧切口癌切除 ,将残胃连同脾脏、胰尾移于胸腔 ,行食管残胃吻合术。主动脉弓上吻合 10例 ,弓后吻合 9例 ,弓下吻合 7例 ;手工吻合 5例 ,器械吻合 2 1例。结果 全组无吻合口瘘和手术早期死亡 ,术后并发症率为 15 .4 %( 4 / 2 6 )。1年生存率 73.9% ( 17/ 2 3) ,3年生存率 5 3.3% ( 8/ 15 ) ,5年生存率 2 8.6 % ( 2 / 7)。结论 采用将残胃、脾脏和胰尾移入胸腔 ,行食管残胃吻合 ,可增加残胃上移高度 ,保证食管残胃的无张力吻合。此术操作简单、创伤小、并发症少 ,可作为消化道重建的方式之一。

Objective To study the treatment method and its effect of esophageal and cardiac carcinoma following subtotal gastrectomy Methods 26 cases were all treated via lateral posterior incision of left thorax The gastric remnant together with the spleen and the tail of pancreas were transplanted into the thoracic cavity The gastric esophageal anastomosis was performed upper aortic arch(10 cases),posterior aortic arch(9 cases),and subaortic arch(7 cases) Artificial anastomosis was performed in 5 cases and mechanical anastomosis in 21 cases Result Anastomotic leakage and early postoperative death were not discovered The incidence of postoperative complications is 15 4%(4/26) 1,3 and 5 year survival is 73 9%(17/23),53 3%(8/15) and 28 6%(2/7)respectively Conclusions The transplantation of gastric remnant accompanied with the spleen and the tail of pancreas can raise the height of the gastric remnant,so to ensure a non tensional anastomosis This method is simple,less trauma and few complications It might act as a useful fashion of digestive tract reconstruction