贲门癌根治术三种径路对比分析  

Comparative Analysis of Three Approaches of Surgical Resection of Cardiac Cancer

作　　者：黄景陶[1] 赵锡江[2] 

机构地区：[1]大连大学附属新华医院胸外科,116021 [2]天津医科大学附属肿瘤医院食管科

出　　处：《天津医药》2005年第9期547-549,共3页Tianjin Medical Journal

摘　　要：目的:比较经腹、经胸及经胸腹联合径路行贲门癌根治术的利弊,指导临床手术径路的选择。方法:随机抽取天津医科大学附属肿瘤医院217例贲门癌根治术患者,从手术损伤、操作便利性、术后恢复、允许的切除范围及术后生存率几方面,对3种径路进行比较。结果:经腹径路失血少、手术时间短;经胸径路上切缘距离最长但全胃切除最少;全胃切除及胰脾联合切除多经胸腹联合径路完成;3种径路的切端阳性率及术后生存率未见显著差异。结论:3种径路各有利弊。对于病变局限于腹内、未侵犯食管或心肺功能较差者,宜选择经腹径路;对于有食管侵犯、而胃部病灶较小、未发现腹内转移的较早期病变,宜经左胸施术;对于病灶较大,胸、腹内均可能存在外侵或淋巴转移,并且能够耐受者,可考虑经胸腹联合径路施术。Objective： To direct the selection of approaches for surgical resection of cardiac cancer by analyzing the merits and defects of the approaches of transabdominal,transthoracic and transabdomino-thoracic. Methods： Two hundred and seventeee cases of surgical resection of cardiac cancer performed in Tianjin cancer hospital were sampled randomly, the concerned resuhes of the three approaches were analyzed in terms of surgical injury, operative convenience, postsurgery rehabilitation, allowable resection range and the survival rate after surgery. Results： The blood loss and operation time of transabdominal were the least. Transthoracic approach had the longest distance of proximal margin, but the least total gastrectomies,Most of the total gastrectomies and the combined resections of pancreas and spleen were performed through the apporach of transabdomino-thoracic. The positive rate of margins and postopertive survival rate of the three groups were not statistically different. Conclusion： The three apporaches have their own merits and defects, the transabdominal approach should be selected for tumours limited in abdomen and not invaded to esophagus and cases that had poor cardiopulmonary function; For early tumours that had esophageal invasion and small gastric focus and abdominal metastasis not be found, the transthoracic approach is a optimal choice; For patients who had a good condition had larger tumor that might have metastasis in both thorax and abdomen, the transabdomino-thoracic approach is recommended.

关 键 词：贲门癌根治术 胸腹联合径路 腹部路径 胸部路径 肿瘤转移 

分 类 号：R735.2[医药卫生—肿瘤] R730.56[医药卫生—临床医学]