经腹纵隔内食管胃黏膜吻合术治疗老年贲门癌  

Transabdominal mediastinal approach for mucosa esophago-gastrostomy in aged people with carcinoma of gastric cardia

作　　者：魏文波[1] 陈海鹏[1] 杨志通[1] 谢容明[1] 

机构地区：[1]广东省揭阳市人民医院外科,广东揭阳522000

出　　处：《中国医药导报》2008年第15期11-12,共2页China Medical Herald

摘　　要：目的:探讨老年贲门癌经腹手术的新手术入路及手术方式。方法:经腹切口,使用悬吊拉钩,切开膈肌脚或食管裂孔弓形部,纵隔内应用浆肌瓣覆盖-食管胃黏膜吻合术治疗老年贲门癌178例。其中,根治性切除140例(78.7%),姑息性切除38例(21.3%),根治术中联合脏器切除18例(10.1%)。对照组老年贲门癌患者170例采用常规经胸手术切除,并行胃食管胸腔吻合。结果:两组所有患者术后均无吻合口漏,切缘均无癌细胞存留,无一例死亡。治疗组术后发生并发症15例(8.4%),对照组术后发生并发症31例(18.2%),两组相比,差异有显著性(P<0.01)。结论:经腹切开膈肌脚,纵隔内行胃浆肌瓣覆盖-食管胃黏膜吻合术,操作在腹腔进行,创伤及生理干扰较小,可提高手术的安全性,减少老年贲门癌患者术后并发症的发生。Objective： To explore the new transabdominal intra-mediastinal operative approach and methods for carcinoma of gastric cardia in aged people.Methods：All the incisions were made at abdominal in all 178 cases. The phrenic roots or esophagus hiatus were incised. The anastomosis of esophagus and stomach were covered by sero-muscular flap of gastric wall, which was the operation of mucosa esophago-gastrostomy. All operations were proximal mostly gastrectomies. The radical operations were performed in 140 cases （78%）, palliative operations in 38 cases （21.3%）, and combined with other organs＇ radical operations in 18 cases （10.1%）. The patients in control group were treated by general operation via thoracic cavity. Results：There were no postoperative leakages of anastomosis, and no cancer cell were left at all the cutting edges. No case died. Postoperative complications appeared in 15 cases （8.42%）and 31 cases （18.2%）respectively, and were of no difference statistically. Conclusion： The transabdominal intra-mediastinal mucosa esophago-gastrectomy is less invasive and influent physiologically. For carcinoma of gastric cardia in aged people, this kind of operation is more safety, and causes less postoperative complications.

关 键 词：贲门癌 食管胃黏膜吻合术 老年人 手术治疗 

分 类 号：R735[医药卫生—肿瘤]