CAJ | 학술논문

目的探讨胃大部切除术后吻合口癌、贲门癌及食管癌的外科治疗.方法回顾性分析21例胃大部切除术后吻合口癌、贲门癌及食管癌患者的临床资料.其中贲门癌术后吻合口癌4例；胃溃疡胃大部切除术后贲门癌2例；胃溃疡胃大部切除术后食管上段癌3例；胃溃疡胃大部切除术后食管中段癌6例；胃溃疡胃大部切除术后食管下段癌6例.行残胃全切+食管部分切除,空肠食管吻合术6例；食管胃部分切除,弓下食管胃吻合3例；食管次全切除结肠代食管12例.结果术后切口感染1例,吻合口瘘1例,1例死于肺部感染,随访20例患者中,4例术后第3年死于心脑血管意外,存活的16例患者饮食基本正常.结论胃大部切除术后吻合口癌、贲门癌及食管癌患者若全身情况许可,无远处转移均应争取手术治疗,消化道重建器官的选择应根据患者首次手术切除情况及术者熟练程度而定.
목적 탐토위대부절제술후문합구암、분문암급식관암적외과치료.방법 회고성분석21례위대부절제술후문합구암、분문암급식관암환자적림상자료.기중분문암술후문합구암4례；위궤양위대부절제술후분문암2례；위궤양위대부절제술후식관상단암3례；위궤양위대부절제술후식관중단암6례；위궤양위대부절제술후식관하단암6례.행잔위전절+식관부분절제,공장식관문합술6례；식관위부분절제,궁하식관위문합3례；식관차전절제결장대식관12례.결과 술후절구감염1례,문합구루1례,1례사우폐부감염,수방20례환자중,4례술후제3년사우심뇌혈관의외,존활적16례환자음식기본정상.결론 위대부절제술후문합구암、분문암급식관암환자약전신정황허가,무원처전이균응쟁취수술치료,소화도중건기관적선택응근거환자수차수술절제정황급술자숙련정도이정.
Objective To discuss the surgical treatment for patients with anastomotic stoma cancer,gastric cardial cancer or esophagus cancer after subtotal gastrectomy.Methods The clinical data of 21 patients with anastomofic stoma cancer,gastric cardial cancer or esophagus cancer after subtotal gastrectomy were analyzed retrospectively.There were 4 cases with anastomotic stoma cancer after operation of gastric cardial cancer,2 cases with gastric cardial cancer after subtotal gastrectomy due to gastric ulcer,3 cases with upper esophagus cancer after subtotal gastrectomy due to gastric ulcer,6 cases with mid-esophagus cancer and 6 cases with distal esophagus cancer after subtotal gastrectomy due to gastric ulcer.There were 6 cases treated with partial esophagus resection,resection of remaining stomach and jejuna-esophagus anastomosis,3 cases treated with partial esophagus and stomach resection and esophagus-gastric anastomosis,12 cases with subtotal esophagectomy and colon interposition.Results One case with incision infection,1 case with anastomosis leaks,1 case dead of pulmonary infection.In the 20 follow-up cases,4 cases were dead of cardiac and cerebral accidents at the third year after operation,and other 16 cases survived and had normal diet.Conclusions Reoperation is still one of the best choices for patients with anastomotic stoma cancer,gastric cardial cancer and esophagus cancer after subtotal gastrectomy when their body condition are acceptable and without distant metastasis.The organ for digestive tract reconstruction should be decided according to the situation of the first gastrectomy and the proficiency of the operator.