Subtotal distal resection of the stomach in cancer: indications and immediate results

摘要

Results of 193 subtotal distal resections of the stomach due to cancer are analyzed. Age of the patients ranged from 25 to 87 years (mean age 57+/-11 years). Reconstruction by Bilrot-I technique was performed most often (67% cases).When Bilrot-II technique was used, classical Gofmeister-Finsterer variant and method on "ultrashort" loop with transverse anastomosis were performed. Extended lymphadenectomy (LAE) was performed in the majority of patients -- 131 (68%) including in D2 volume -- 111 (58%), in D3 - 20 (10%). Combined surgeries were carried out in 23 (12%) patients. The following intraoperative complications were seen: trauma of the spleen (2 patients, splenectomy was performed) and an injury of the portal vein during removing of the lymph nodes of 8b group (1 patient, wound of the vein was sutured). Postoperative complications were seen in 37 (19,2%) patients. There was one case of insufficiency of gastric anastomosis due to surgical mistake. Two patients died (1 after stomach resection with LAE in D1 and 1 -- after one in D3), lethality was 1%. Mesenterial thrombosis and perforation of acute ulcer of the gastric stump were the causes of death. It is demonstrated that LAE in D2 scope doesn't influence immediate results of distal resection of the stomach in cancer. LAE in D3 scope compared with D2 is associated with increased number of complications. neposredstvennye rezul'taty.