残胃状态下食管癌与贲门癌的外科治疗策略

摘要

Objective:To investigate the surgical treatment of primary esophageal and cardia carcinoma of remnant stomach. Method:From January 2005 to December 2012 in our hospital,8 cases of patients with primary esophageal or cardia carcinoma of remnant stomach were underwent radical surgical resection. Result:The average time of the 8 cases of patients under the condition of gastric stump was 11.7 years,2 cases were underwent subtotal gastrectomy with Billroth I reconstruction,and 6 cases were underwent Billroth II reconstruction. Then 2 cases of patients with esophageal carcinoma were accepted Triple-incision esophagectomy combined replacement with colon;6 cases of patients with cardiac carcinoma all through the abdominal incision,2 cases were accepted cardiac carcinoma and the lower esophagus resection combined Jejunal interposition esophageal anastomosis, 4 cases were accepted cardia carcinoma and remnant gastric resection combined P-shaped jejunal loop on behalf of the stomach Roux-en-Y anastomosis. Conclusion:For gastrectomy patients in the gastric remnant state,the early or locally advanced esophageal or cardiac carcinoma can also be underwent radical surgery resection. Before surgery,selecting the appropriate individualized surgical plan on the basis of patient’s lesions,can achieve the desired therapeutic effect.%　　目的：探讨残胃状态下食管癌及贲门癌的外科治疗策略。方法：本院自2005年1月-2012年12月共收治残胃状态下食管癌及贲门癌患者8例，均行外科根治性手术治疗。结果：本组8例确诊患者的残胃状态时间平均为11.7年，其中Billroth I式吻合术者2例；Billroth II式吻合术者6例；2例食管癌患者行三切口食管癌切除联合结肠代食管术，6例贲门癌患者均经腹部手术切口，2例行贲门癌下段食管切除联合间置空肠代食管吻合术，4例行贲门癌残胃全切除联合P形空肠袢代胃Roux-en-Y式吻合术。结论：对于胃大部切除后残胃状态下的患者，早期或局部晚期的食管癌与贲门癌亦可行根治性手术，手术前需根据患者病变情况，选择合适的个体化手术方案，同样可以达到理想的治疗效果。