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目的 探讨治疗贲门癌手术入路新方法及不同胃切除范围的的综合疗效。方法 自 1992 -0 1～ 2 0 0 2 -0 1共经腹手术治疗贲门癌 78例 ,其中全胃切除P型空肠袢代胃术 3 0例 ,近端胃大部切除术 48例 ,术后随访时间 6个月～ 5年。结果 切除肿瘤上方食管 >5cm ,切缘无癌残留 ,清除的纵隔下部淋巴结转移率达 18 4%。全胃组 5年存活率大于近侧胃大部切除术组 ,返流性食管炎发生率明显低于近侧胃大部切除术组。结论 对Ⅲ期肿瘤患者或Ⅱ期发现No5、6组淋巴结有转移者应行根治性全胃切除术 ,P型空肠袢代胃术符合生理要求 ,并发症少。经腹手术安全彻底 ,但有一定的适应症
Objective To explore the comprehensive treatment of cardia cancer surgical approach and different gastrectomy range of comprehensive efficacy. Methods A total of 78 cases of cardia cancer were treated by abdominal surgery from 1992 -0 1 to 2 0 0 2 -0 1. Among them, 30 cases received total gastrectomy for P type jejunum and 40 cases for proximal gastrectomy, Follow-up time of 6 months to 5 years. Results Excision of esophagus above the tumor> 5cm, no margin of cancer margin, the removal of mediastinal lymph node metastasis rate of 18 4%. The 5-year survival rate of the whole stomach group was greater than that of the proximal gastrectomy group, and the incidence of reflux esophagitis was significantly lower than that of the proximal gastrectomy group. Conclusions The radical total gastrectomy should be performed on patients with stage Ⅲ tumors or patients with metastasis of stage No5 and 6 lymph nodes in stage Ⅱ. The P - type jejunum on behalf of the stomach surgery meets the physiological requirements with few complications. Transabdominal surgery safe and complete, but there are some indications