进展期贲门癌的外科手术治疗

Surgical therapy for developing cardiac cancer

目的 探讨进展期贲门癌的外科手术治疗。方法 回顾分析 5 8例贲门癌手术治疗临床资料 ,研究切口改进、淋巴结清扫、胃切除范围及联合脏器切除的意义。结果 NO1～NO4淋巴结转移 76% ,PT2 时第二站淋巴结 (N2 )转移 45 % ,PT3 、PT4和N2和第三站淋巴结 (N3 )转移明显增高。 3年生存率 3 2 .7% ,5年生存率 15 .5 %。结论 ①胸腹联合切口的改进能减小手术创伤 ;②进展期贲门癌应常规选择D2 、D2 + 或D3 术式 ;③PT3 或NO5、NO6转移应行全胃切除。PT3 常伴NO10、NO11转移或可疑转移应联合脾脏切除以利清扫淋巴结 ;④联合胰体尾、脾及其它脏器切除可明显提高进展期贲门癌切除率。

Objective To explore the surgical therapy for developing cardiac cancer. Methods The postoperative clinical data from 58 patients with cardiac cancer admitted in our hospital from 1996 to 2003 were analyzed retrospectively. The significance in the modification of incisions, removal of lymph nodes, the range of the stomach removed, and combined removal of organs was also analyzed. Results The percentage of lymph node metastasis in NO1-NO4 was 76%. N 2 lymph node metastasis in PT 2 was 45%. Occurrence of N 2 and N 3 lymph node metastases in stages PT 3 and PT 4 increased significantly. Three-year and five-year survival rates were 32.7% and 15.5%, respectively. Conclusion Modified abdominothoracic incision can attenuate surgical trauma. Better options for developing cardiac cancer include D 2, D 2+ , or D 3 surgical procedure. Total gastrectomy should be performed on patients with cardiac cancer with NO5 or NO6 and in stage PT 3. Combined removal of the spleen should be conducted in patients with cardiac cancer in stage PT 3 usually accompanied by NO10 and NO11 metastases or by the suspicious ones. Combined removal of the spleen, the pancreas body or tail, and other organs can increase the clearance rate of the developing cardiac cancer remarkably.