中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2012年
9期
906-909
,共4页
任明扬%黄斌%张军%蒲敏%邓思寒
任明颺%黃斌%張軍%蒲敏%鄧思寒
임명양%황빈%장군%포민%산사한
食管胃交界部腺癌%腹腔镜手术%经膈肌裂孔近端胃切除术%治疗效果
食管胃交界部腺癌%腹腔鏡手術%經膈肌裂孔近耑胃切除術%治療效果
식관위교계부선암%복강경수술%경격기렬공근단위절제술%치료효과
Adenocarcinoma of the esophagogastric junction%Laparoscopic operation%Transhiatal proximal gastrectomy%Treatment outcomes
目的 探讨腹腔镜经膈肌裂孔近端胃切除治疗食管胃交界部腺癌(AEG)的安全性及近期临床效果.方法 回顾2008年8月至2011年5月接受腹腔镜经膈肌裂孔近端胃切除术治疗的98例AEG患者的临床资料,分析手术时间、术中出血情况、食管切除长度、淋巴结清扫情况及术后近期并发症.结果 腹腔镜下完成近侧胃切除术96例,中转开腹2例(联合脾切除术1例,联合脾脏、胰尾切除术1例).手术时间( 224.1 ±33.7) min；术中出血(69.4±26.1)ml;切除食管长度(4.0±0.6) cm;术后病检切缘均无癌残留;获取淋巴结(16.4±5.7)枚/例.术中损伤胸膜14例,损伤脾脏3例；术后吻合口瘘1例,无吻合口狭窄、术后出血、切口(包括穿刺孔)感染及围手术期死亡病例.随访时间3～30个月,术后1个月和3个月反流性疾病问卷表评分分别为(9.9±4.4)和(9.3±4.3),无切口(包括穿刺孔)癌种植,随访期间死亡5例.结论 腹腔镜经膈肌裂孔近侧胃切除治疗AEG安全可行,近期临床效果较好.
目的 探討腹腔鏡經膈肌裂孔近耑胃切除治療食管胃交界部腺癌(AEG)的安全性及近期臨床效果.方法 迴顧2008年8月至2011年5月接受腹腔鏡經膈肌裂孔近耑胃切除術治療的98例AEG患者的臨床資料,分析手術時間、術中齣血情況、食管切除長度、淋巴結清掃情況及術後近期併髮癥.結果 腹腔鏡下完成近側胃切除術96例,中轉開腹2例(聯閤脾切除術1例,聯閤脾髒、胰尾切除術1例).手術時間( 224.1 ±33.7) min；術中齣血(69.4±26.1)ml;切除食管長度(4.0±0.6) cm;術後病檢切緣均無癌殘留;穫取淋巴結(16.4±5.7)枚/例.術中損傷胸膜14例,損傷脾髒3例；術後吻閤口瘺1例,無吻閤口狹窄、術後齣血、切口(包括穿刺孔)感染及圍手術期死亡病例.隨訪時間3～30箇月,術後1箇月和3箇月反流性疾病問捲錶評分分彆為(9.9±4.4)和(9.3±4.3),無切口(包括穿刺孔)癌種植,隨訪期間死亡5例.結論 腹腔鏡經膈肌裂孔近側胃切除治療AEG安全可行,近期臨床效果較好.
목적 탐토복강경경격기렬공근단위절제치료식관위교계부선암(AEG)적안전성급근기림상효과.방법 회고2008년8월지2011년5월접수복강경경격기렬공근단위절제술치료적98례AEG환자적림상자료,분석수술시간、술중출혈정황、식관절제장도、림파결청소정황급술후근기병발증.결과 복강경하완성근측위절제술96례,중전개복2례(연합비절제술1례,연합비장、이미절제술1례).수술시간( 224.1 ±33.7) min；술중출혈(69.4±26.1)ml;절제식관장도(4.0±0.6) cm;술후병검절연균무암잔류;획취림파결(16.4±5.7)매/례.술중손상흉막14례,손상비장3례；술후문합구루1례,무문합구협착、술후출혈、절구(포괄천자공)감염급위수술기사망병례.수방시간3～30개월,술후1개월화3개월반류성질병문권표평분분별위(9.9±4.4)화(9.3±4.3),무절구(포괄천자공)암충식,수방기간사망5례.결론 복강경경격기렬공근측위절제치료AEG안전가행,근기림상효과교호.
Objective To explore the safety and short-term efficacy of laparoscopic transhiatal proximal gastrectomy in patients with adenocarcinoma of the esophagogastric junction.Methods From Aug 2008 to May 2011,98 patients with adenocarcinoma of the esophagogastric junction underwent laparoscopic transhiatal proximal gastrectomy.Clinical data were analyzed retrospectively including operative time,estimated bleeding,length of resection,lymph node dissection,and short-term postoperative complications.Results Ninety-six patients underwent laparoscopic transhiatal proximal gastrectomy successfully and 2 were converted to open operation (one for combined splenectomy and the other combined splenectomy and resection of the tail of the pancreas).The mean operative time was (224.1±33.7) min and the mean blood loss was (69.4±26.1) ml.The mean length of esophageal resection was (4.0±0.6) cm and the resection margin was negative.The number of lymph node removed was 16.4± 5.7.Pleural laceration occurred in 14 cases and spleen injury occurred in 3 case during operation.There was one anastomotic leakage.There were no postoperative mortalities,bleeding,anastomotic stenosis and wound infection.After follow-up ranging from 3 to 30 months,the value of reflux diagnostic questionnaire (RDQ) was 9.9±4.4 at 1 month and 9.3±4.3 at 3 months postoperatively.No incision metastasis was found and 5 patients died.Conclusion Laparoscopic transhiatal proximal gastrectomy is safe for patients with adenocarcinoma of the esophagogastric junction and the short-term clinical outcomes are favorable.
