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目的 介绍应用腹部正中切口联合左前胸肋间小切口行全胃切除胸腔内Lygidakis代胃术治疗胃癌 2 9例的方法。方法 2 9例患者右 4 5°侧卧位 ,腹部正中切口 ,联合第 7肋间小切口入胸 ,切除全胃 ,清扫各组淋巴结。用Lygidakis空肠代胃 ,在胸腔内行食管空肠端侧吻合。结果 全组均根治性切除 ,无吻合口瘘 ,无反流性食管炎、倾倒综合征发生和上切端癌残留。术后胸腔引流 1 80～ 5 2 0ml,平均 32 0ml,2 8例痊愈出院 ;1例全胃切除患者术后 5天因切口感染 ,呼吸衰竭死亡 ,占 3.7%。术后 1、3年生存率分别为 76 .9%和4 2 .3%。结论 应用Lygidakis空肠代胃术胸内重建消化道具有良好代胃、防止反流性食管炎、倾倒综合征之优点 ,术后生存率高 ,该手术入路患者术后疼痛轻 ,对心肺功能干扰小 ,而且术后并发症少 ,患者恢复快 ,值得应用。
Objective To introduce a method of total gastrectomy for intrathoracic Lygidakis on gastric cancer in 29 cases with gastric cancer treated with a median incision of the abdomen and a small incision in the left anterior chest. Methods Twenty-nine patients underwent a right lateral incision of 45 ° and a median incision in the abdomen. Combined with a small intercostal incision into the thoracic cavity, the whole stomach was resected and the lymph nodes of each group were dissected. With Lygidakis jejunum on behalf of the stomach, in the thoracic esophageal jejunal end anastomosis. Results All patients underwent radical resection, no anastomotic fistula, no reflux esophagitis, dumping syndrome and end-cancer. Postoperative chest drainage 180 ~ 520ml, an average of 32ml, 28 cases were discharged; 1 case of total gastrectomy patients 5 days after incision infection, respiratory failure, accounting for 3.7%. The 1-year and 3-year survival rates were 76.9% and 42.3% respectively. Conclusions The application of Lygidakis jejunum on the thoracic reconstruction of gastrointestinal tract has the advantages of good gastric replacement, prevention of reflux esophagitis and dumping syndrome, and high postoperative survival rate. Postoperative patients with this operation have less pain and have less interference with cardiopulmonary function , And less postoperative complications, patients recover quickly, it is worth applying.