保留贲门的近端胃癌根治术新术式探讨(附16例报告)  

Discussion on a new operation-reserving cardia in proximal radical gastrectomy with 16 cases

作　　者：王宽[1] 薛英威[1] 

机构地区：[1]哈尔滨医科大学第三临床医学院胃肠外科,黑龙江哈尔滨150081

出　　处：《哈尔滨医科大学学报》2007年第6期596-598,共3页Journal of Harbin Medical University

摘　　要：目的 探讨部分近端胃癌根治术中保留贲门的可能性及适应证。以术中病理为保障，在不影响根治手术效果的前提下，保留食管-胃括约肌的解剖生理结构，观察这种新术式对患者生存质量的影响。方法 将2003-2004年拟行近端胃癌根治手术的病人前瞻性随机分为两组，根治手术切除成功者为合格样本，对照组行传统近端胃癌根治术，实验组行保留贲门的近端胃癌根治术，两组均采用环形吻合器械重建消化道；均行一致的幽门成形术；均保留迷走神经腹腔分支及肝胆分支；均进行上、下切端组织术中病理检查以保证根治手术范围。进行比较的指标包括：术后吻合口瘘几率、平均肠道恢复时间、住院时间、术后半年随访时营养状况及返流情况。结果 实验组，对照组：吻合口瘘0／0；肠道恢复时间4．3／4．7天；住院时间：12．1／10．2天；术后2个月随访时营养状况比较实验组明显优于对照组；监测食管返流情况、食管黏膜炎症改变明显优于对照组（P〈0．01）。结论 若严格的把握适应证，保留贲门近端胃癌根治术适用于部分胃底、体癌，无论从胃切除范围还是淋巴结清除范围都能达到根治要求，改善病人生存质量的同时有效防止返流性食管炎的发生。Objective To study the possibility and applicability of reserving the cardia in proximal radical gastreetomy, partially. Base on the rapid pathological examination within operation, with the condition- no decreasing the radical level, we designed a new operation way for reserving the esophagus - cardia physiological structure, and observed the effect on patients＇ quality of life postoperatively. Methods From 2003 to 2004, 32 patients entered this Study eventually. In this randomized prospective study, they were divided into two groups： A and B. Patients in A group, accepted traditional proximal gastrectomy; whereas, patients in B group, accepted cardia reserved operation. For the echo condition, both groups followed the rules： ages were between 40 to 70; same circle stapler machines were preformed in anastomosis procedure; the vagus nerve divisions were preserved; no cancer ceils were detected by pathological testing in the upper and lower cutting curve tissues. The ratio of fistula, mean gastrointestinal recover time, hospi.talizing time, nutritional status and reflux situation 2 months postoperatively were investigated and compared fordifferenced between the two groups. Results A group vs B group： anastomose fistula 0/0; resuming of gastrointestinal function 4.3/4.7 （day）; average time in hospital postoperativelyl2.1/10.2（day） ; the nutritional status is obviously better than that in B group 2 month postoperatively; whereas, reflux status is significant different between the two groups （ P 〈 0.01）. Conclusion Following the rules strictly, the cardia could be reserved safely in part of upper gastric cancers. From this study, we approved that reserving the cardia in proximal radical gastrectomy is an effective method to reduce the occurrence of reflux and improve the quality of life greatly. So, this is a potential and recommendable operation.

关 键 词：近端胃癌根治术 保留贲门 消化液返流 

分 类 号：R735.2[医药卫生—肿瘤]