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我科自1990年3月至1992年7月,采用先开腹后开胸、不切断肋弓、不切开膈肌及保留膈神经的手术方法,对30例近端胃及贲门癌进行了根治性切除。此方法暴露好,切除彻底,对病人的创伤小,能减少术后并发症,现总结如下。临床资料本组共30例,其中男21例,女9例,年龄45～68岁。胃小弯癌侵犯贲门者18例,贲门癌12例。30例病人术前均经X线片、胃镜检查及病理证实。手术步骤病人取右侧斜卧位,先行上腹正中切口,充分暴露术野,按胃癌根治术的淋巴结清扫原则和手术步骤进行腹部清扫,但要注意保护胃网膜右血管弓。待腹腔清扫完成后,自预定切断处切断胃体,把远端残胃关闭暂留在腹腔,近端残胃用大圆针粗丝线U字套针缝合并用干纱布包裹,准备进胸腔,腹部手术结束。
In our department, from March 1990 to July 1992, 30 cases of radical gastrectomy and cardia cancer were treated with a laparotomy, thoracotomy, no rib arch, no diaphragm incision, and retained sacral nerve. Sexual resection. This method is well exposed, thorough resection, minimal trauma to the patient, and reduced postoperative complications, as summarized below. Clinical data in this group of 30 cases, including 21 males and 9 females, aged 45 to 68 years old. Gastrointestinal cancer invaded the cardia in 18 cases and cardiac cancer in 12 cases. All 30 patients were confirmed by X-ray, gastroscopy, and pathology before surgery. Surgical procedure The patient takes the right side of the incline position, the first abdominal midline incision, fully exposed the operative field, according to the principle of lymph node dissection of gastric cancer surgery and surgical procedures for abdominal dissection, but should pay attention to protect the right gastroepiploic vascular arch. After the abdominal cavity is cleaned, the stomach body is cut off at the scheduled cutting site, and the distal stomach is closed and left in the abdominal cavity. The proximal stomach is sutured with a large round needle thick thread U-shaped trocar and wrapped with dry gauze, ready to enter the chest cavity, abdominal surgery End.