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目的探讨经腹进展期胃上部癌手术治疗的方法及疗效。方法选择进展期胃上部癌患者176例,行经腹手术治疗。均在癌灶以上4-5cm切断食管,其中全胃切除术121例(食管空肠Roux-Y吻合术117例,间置空肠代胃术4例,其中合并联合脏器切除13例),近端胃切除术55例。结果 176例均经腹行胃上部癌根治性切除术,吻合后食管切环完整,病理切片检查食管无切缘癌残留。全组发生吻合口瘘2例,吻合口狭窄5例,总体疗效良好。26例术后出现程度不等的反流性食管炎,经对症处理后缓解。结论釆用经腹途径治疗进展期胃上部癌,能提高肿瘤的根治性切除率,预防剖胸手术的并发症。
Objective To investigate the surgical treatment of upper abdominal cancer with advanced abdominal transection and its curative effect. Methods 176 patients with advanced gastric cancer were selected and treated with transabdominal surgery. Esophagectomy was performed at 4-5 cm above the foci, including 121 cases of total gastrectomy (117 cases of Roux-Y anastomosis in esophagus and jejunum, 4 cases of intercostal jejunal replacement, including 13 cases of combined resection of organ), proximal Gastrectomy in 55 cases. Results All the 176 cases undergone radical gastrectomy for upper gastric cancer were performed. The anastomosis of the esophagus was complete and the pathological examination of the esophageal unrelated margin was performed. The whole group occurred in 2 cases of anastomotic leakage, anastomotic stenosis in 5 cases, the overall effect is good. 26 cases of postoperative reflux of esophagitis varying degrees, symptomatic relief after treatment. Conclusion The use of transabdominal approach for the treatment of advanced gastric cancer can improve the radical resection of the tumor and prevent the complications of thoracotomy.