管状胃纵隔化在微创胃底贲门癌切除术中的应用研究  

Application of tubular gastric mediastinalization in minimally invasive resection of gastric fundus and cardia cancer

作　　者：张冬蕾[1] 钱昌林[2] 魏华兵[1] 周力璜[1] 钱晓哲[1] ZHANG Dong-lei;QIAN Chang-lin;WEI Hua-bing;ZHOU Li-huang;QIAN Xiao-zhe(Department of Thoracic Surgery,South Campus,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201112,China;Department of General Surgery,South Campus,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201112,China)

机构地区：[1]上海交通大学医学院附属仁济医院南院胸外科,上海闵行201112 [2]上海交通大学医学院附属仁济医院南院普外科,上海闵行201112

出　　处：《中国现代普通外科进展》2020年第12期937-940,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨管状胃纵隔化在微创胃底贲门癌切除术中的应用疗效。方法:选取2016年1月至2018年12月我院收治的符合入组标准的30例胃底贲门癌患者,通过腹腔镜联合胸腔镜辅助小切口行微创胃底贲门癌切除术,术中管状胃纵隔化,记录胸腹部手术时间、管状胃制作时间、术中总出血量、淋巴结清扫数目、住院时间、住院总费用及围术期并发症等。结果:入组患者均顺利完成手术,术中无并发症发生,围术期无死亡病例。腹部手术时间(96.3±12.5)min;胸部手术时间(62.4±7.8)min;管状胃制作时间(28.6±4.3)min;术中总出血量(287.1±20.8)mL;淋巴结清扫数目(36.5±5.4)个;住院时间(12.8±2.2)d;住院总费用(6.6±0.5)万元。围术期并发症4例,术后局限吻合口瘘1例,胃排空障碍3例,经保守治疗后均康复。随访1年,患者并发症发生率为13.3%(4/30),生存率为86.7%(26/30),复发率为6.7%(2/30)。结论:在合理选择手术适应证的前提下,腹腔镜联合胸腔镜辅助小切口行微创胃底贲门癌切除术,术中管状胃纵隔化,疗效确切、安全性高,具有临床推广价值。Objective:To explore the effect of tubular gastric mediastinalization in minimally invasive resection of gastric fundus and cardia cancer.Methods:30 patients with gastric fundus and cardia cancer in our hospital from January 2016 to December 2018 were selected,laparoscopy combined with thoracoscopy was used for radical gastrectomy of gastric fundus and cardia cancer,mediastinalization of tubular gastric during operation,operation time,time of making tubular gastric,intraoperative bleeding volume,number of lymph node dissection,hospitalization time,total cost of hospitalization and perioperative complications were counted.Results:No complications occurred during the operation and no death occurred during the perioperative period.Abdominal operation time(96.3±12.5)min;thoracic operation time(62.4±7.8)min;time of making tubular gastric(28.6±4.3)min;intraoperative bleeding volume(287.1±20.8)ml;number of lymph node dissection(36.5±5.4);hospitalization time(12.8±2.2)d;total cost of hospitalization(6.6±0.5)ten thousand yuan;There were 4 cases of perioperative complications,1 case of anastomotic fistula after operation and 3 cases of gastric emptying disorder.The above patients all recovered after active conservative treatment.During the 1-year follow-up period,the incidence of complications in the minimally invasive group was 13.3%(4/30),the survival rate was 86.7%(26/30),the recurrence rate was 6.7%(2/30).Conclusion:Under the premise of reasonable operation indications,laparoscopic combined with thoracoscopy for radical gastrectomy of gastric fundus and cardia cancer,mediastinalization of tubular gastric during the operation,is a method with accurate effect and high safety.It has certain clinical promotion value.

关 键 词：胃肿瘤 贲门癌切除术 管状胃 纵隔化 

分 类 号：R655.4[医药卫生—外科学]