三种不同径路手术治疗残胃贲门癌的临床分析  

Clinical Analysis on Surgical Treatment of Residual Gastric Cardia Cancer via Three Different Approaches

作　　者：杨景先 林帆[2] 陈晓锋 王侦伟 杨卓涛 余颖誉 麦建全 

机构地区：[1]广东省饶平县人民医院肿瘤外科,饶平515700 [2]广州市第一人民医院,广州510018

出　　处：《中国现代手术学杂志》2015年第1期21-23,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的比较经胸、经腹和胸腹联合三种手术路径治疗残胃贲门癌的临床效果。方法回顾性分析我院1998年1月-2014年11月手术治疗的36例残胃贲门癌患者的临床资料,按手术径路分为经胸组、经腹组和腹胸联合组,各12例,分别采取经胸、经腹和胸腹联合路径手术。分析比较三组患者的切口长度、手术时间、术中出血量、术后住院时间、淋巴结清除数目、食管残端阳性率、术后并发症等指标。结果三组间切口长度、手术时间及术中出血量比较,差异均具有统计学意义（P〈0.05）,经腹组此三项数值均最低。而在术后住院时间、淋巴结清除平均数和术后食管残端阳性率比较,三组间差异均无统计学意义（P〉0.05）。A组术后并发症3例（25%）,分别为肺部感染、吻合口瘘和反流性食管炎各1例;B组术后吻合口瘘1例（8.3%）;C组术后并发症7例（58.3%）,其中肺部感染4例,切口感染2例,反流性食管炎1例;三组间并发症率比较差异有统计学意义（P=0.026）。结论经胸、经腹、腹胸联合三种不同手术路径治疗残胃贲门癌各有优缺点及适应证,手术前应根据患者具体情况做出个体化的选择。Objective To compare the effects of surgical intervention of residual gastric cardia cancer via thoracic,abdominal or chest-abdominal approach. Methods The clinical data of 36 cases with residual gastric cardia cancer admitted from January 1998 to November 2014 were analyzed retrospectively. According to surgical approaches,they were divided into group A,B and C with 12 cases for each and performed gastrectomy via thoracic,abdominal and chest-abdominal approach respectively. The incision length,operative duration,intra-operative blood loss,post-operative hospitalization,clearance number of lymph node,positive rate of esophageal stump and post-operative complication were compared among the three groups. Results The incision length,operative duration and intra-operative blood loss had statistical difference between three groups,and all were lowest in group B（ P〈0. 05）. There was no statistical difference in post-operative hospitalization,clearance number of lymph node,positive rate of esophageal stump among the three groups（ P〉0. 05）. Three cases（ 25%） were found post-operative complications in group A with pulmonary infection,anastomotic stoma fistula and reflux esophagitis for each; One case was found anastomotic stoma fistula in group B; Seven cases were found complications in group C,including 4 of pulmonary infection,2 of incision infection and 1 of reflux esophagitis. There was statistical difference in post-operative complication among three groups（ P = 0. 026）.Conclusion The thoracic,abdominal or chest-abdominal approach has its indication,merit and demerit,and the appropriate approach would be selected according to patient＇s conditions.

关 键 词：残胃 贲门肿瘤 手术入路 

分 类 号：R735.2[医药卫生—肿瘤]