顺行法胃大部切除术在胃癌手术中的应用  

作　　者：詹利永[1] 蒋红钢[1] 陆伯豪[1] 王敏[1] 陈徐艰[1] 

机构地区：[1]浙江省嘉兴学院附属第一医院肿瘤外科,314000

出　　处：《浙江临床医学》2005年第5期467-468,共2页Zhejiang Clinical Medical Journal

摘　　要：目的探讨顺行法胃大部切除在胃癌手术中的应用价值。方法回顾分析2000年1月至2003年12月本科采用顺行法胃大部切除术治疗进展期胃癌116例的临床病理资料。结果根治性胃切除78例,姑息性胃切除38例。联合横结肠及其系膜切除14例,肝左外叶切除2例,胰十二指肠切除3例。共清扫淋巴结2331枚,每例平均为20.1枚,其中758枚存在癌转移,转移率为32.53%;术中出血80～600ml,平均每例154ml;手术时间100～210min,平均135min。联合胰十二指肠切除术后胰漏死亡1例,肺部感染5例,无吻合口漏、切口感染、腹腔感染、腹腔出血和吻合口狭窄。结论顺行法胃大部切除治疗胃癌是可行的。其最大优点是可减少和避免对病变的刺激,符合外科无瘤操作和无触摸胃癌根治术原则。Objective To evaluate the value of antegrade subtotal gastrectomy in the operation of gastric carcinoma. Methods The clinical data of 116 patients with advanced gastric carcinoma who underwent the antegrade subtotal gastrectomy from January 2000 to December 2003 were analyzed (retrospectively). Results Seventy eight patients were underwent radical gastrectomy and thirty eight patients underwent palliative gastrectomy.Transverse colon and transverse mesocolon was resected in 14 patients, exite of left liver in 2 patients and pancraticoduodenectomy in 3 patients. There were 2331 pieces of removed lymph nodes (average 20.1 pieces per case). Among these removed lymph nodes, 758 pieces were proved to be carcinoma metastasis. The rate of carcinoma metastasis was 32.53 percent. Intro-operative hemorrhage volume was from 80 ml to 600 ml (average 154 ml )and the operative time from 100 min to 210 min (average 135 min).One patient died of pancreatic fistula after pancraticoduodenectomy and five patients had pulmonary infection. There were no fistula and constriction of stoma, no infection of incisional wound and abdominal cavity, and no hemorrhage of abdominal cavity in all patients. (Conclusion) It is feasible to treat gastric carcinoma with antegrade subtotal gastrectomy. The max virtue of this method is to decrease or avoid stimulation to the lesion and fit the principles of an-neoplasia surgical operation and an-touch radical excision of gastric carcinoma.

关 键 词：胃大部切除术 顺行法 手术中 胰十二指肠切除 临床病理资料 根治性胃切除 姑息性胃切除 肝左外叶切除 进展期胃癌 2003年 2000年 肠切除术后 吻合口狭窄 胃癌根治术 应用价值 回顾分析 术中出血 手术时间 肺部感染 吻合口漏 

分 类 号：R735.2[医药卫生—肿瘤]