胃切除术后残胃部癌、贲门部癌、食管部癌的外科手术治疗  

Surgical Treatment for Remnantstump Gastric,Cardiac or Esophageal Carcinoma in Patients after Gastrectomy

作　　者：仇德惠[1] 徐松涛[1] 王群[1] 郑如恒[1] 徐正浪[1] 曾亮[1] 谭黎杰[1] 

机构地区：[1]复旦大学附属中山医院胸外科,上海200032

出　　处：《复旦学报（医学版）》2002年第1期71-74,共4页Fudan University Journal of Medical Sciences

摘　　要：目的　总结胃大部或全胃切除术后因残胃部癌、贲门部癌或食管部癌再次手术的治疗经验。方法　将86例按肿瘤部位浸润范围归纳为 6类 ,施行不同手术方式。①残胃部癌 13例 ,9例施行了全胃切除、食管空肠吻合 ;②残胃贲门部癌 4 6例 ,3 8例施行了全胃贲门和食管部分切除、食管空肠吻合 ;③贲门部癌 8例 ,直径小于 3cm ,施行贲门部食管胃局部切除、食管残胃胸内吻合 ;④食管下段部癌 11例 ,施行食管下段及胃贲门部切除、空肠或结肠代食管术 ;⑤胃大部切除术后食管中段部癌 7例 ,5例施行了全食管切除、结肠代食管术 ;⑥全胃切除食管空肠襻式吻合术后食管中段部癌 1例 ,施行食管大部切除 ,倒转近端空肠襻代食管 ,食管空肠弓上吻合、空肠空肠吻合。结果　 72例再次手术切除了肿瘤 ,手术切除率 83 .7%。术后 2例分别死于结肠坏死和呼吸衰竭。术后吻合口瘘 3例 ,吻合口狭窄 6例 ,切口感染 7例 ,脓胸 3例 ,膈下感染 3例 ,剖胸止血 1例 ,结肠坏死 1例。随访 1989～ 1999年 5 5例切除病人 ,术后平均寿命超过 2年。结论　胃大部或全胃切除术后残胃部癌、贲门部癌或食管部癌仍应采用积极外科手术为主的综合治疗方案 ,选用合适手术方式 ,注重手术质量 。Purpose: To summarize the therapeutic experience of surgical treatment for remnantstump gastric, cardiac or esophageal carcinoma in patients after gastrectomy. Methods: We divided 86 cancer patients into 6 groups according to the infiltration area. Different operation programs were selected according to the classification. 1 Among 13 cases of gastric stump cancer, we removed the whole remnant stomach and performed esophagojejunostomy in 9 cases. 2 Among 46 cases of remnantstump gastric and cardiac cancer, we removed the whole remnant stomach and part of the esophagus and performed a Roux-y esophagojejunostomy in 38 cases. 3 In 8 cases of cardiac cancer, we resected the tumor located in the cardia and performed thoracic anastamosis between the esophagus and remnant stomach. 4 Eleven cases of lower part of esophageal cancer accepted esophagogastrectomy. And we reconstructed the esophagus with colon or jejunum. 5 Seven cases of middle part of esophageal cancer underwent subtotal gastrectomy. We used part of the colon in reconstruction for subtotal esophagectomy. 6 One case of middle part of esophageal cancer underwent total gastrectomy. We reversed part of the jejunum in reconstruction for subtotal esophagectomy. Results: We successfully resected the tumor in 72 patients with a resection rate of 83.7%. Two patients died among the 86 patients, one died of colon necrosis, the other died of pulmonary failure after surgery. Except that, there were 3 patients of anastomotic leakage, 6 cases of anastomotic stoma stenosis, 7 cases of infection of incision wounds, 3 cases of pyothorax, 3 cases of subphrenic absces and 1 case of bleeding after surgery. The average life span after surgery was two years of the 55 patients from 1989 to 1999. Conclusions: Gastrectomy or esophagectomy and reconstruction are more risky and complicated in patients who have already undergone gastrectomy. However, in patients who suffer from remnantstump gastric, cardiac or esophageal carcinoma after subtotal or total gastrectomy, surgical treatment

关 键 词：胃切除术 残胃部癌 贲门部癌 食管部癌 再手术 

分 类 号：R656.61[医药卫生—外科学] R735[医药卫生—临床医学]