[1]王可毅,闫天生,崔睿,等.经胸腹联合小切口手术治疗贲门癌[J].中国微创外科杂志,2008,08(1):72-74.
　Wang Keyi,Yan Tiansheng,Cui Rui,et al.Thoracoabdominal Miniincision Surgery for the Treatment of Gastric Cardia Cancer[J].Chinese Journal of Minimally Invasive Surgery,2008,08(1):72-74.
点击复制

经胸腹联合小切口手术治疗贲门癌()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
08
期数:
2008年1期
页码:
72-74
栏目:
出版日期:
2008-10-22

文章信息/Info

Title:
Thoracoabdominal Miniincision Surgery for the Treatment of Gastric Cardia Cancer
作者:
王可毅; 闫天生; 崔睿; 王京弟; 沈祯云; 刘丹丹
北京大学第三医院胸外科，北京100083
Author(s):
Wang Keyi;  Yan Tiansheng;  Cui Rui;  et al.
Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
关键词:
微创胸腹联合小切口; 贲门癌; 贲门癌根治术
Keywords:
Thoracoabdominal miniincision; Gastric cardia cancer; Radical resection of cardia cancer
分类号:
R735
文献标志码:
A
摘要:
目的探讨胸腹联合小切口在贲门癌手术中的应用效果。方法我科于2002年1月～2007年1月对60例贲门癌患者行贲门癌切除术，经胸腹联合小切口30例，经后外侧切口30例，回顾分析2组资料。结果手术均获成功，无手术死亡及严重并发症发生。与后外侧切口组相比，胸腹联合小切口组的切口长度短［(12.4±0.7)cm vs （19.2±2.0）cm，t=-17.577，P=0.000］，手术时间短［(207.3±76.1)min vs （260.0±85.6）min，t=-2.519，P=0.015］，开始下床活动早［(2.3±0.5)d vs (3.4±0.5)d,t=-8.521,P=0.000］,胸腔引流量少［(276.7±58.7)ml vs (308.7±59.5)ml,t=-2.097,P=0.040］,哌替啶用量少［(66.7±27.3)mg vs (113.3±45.4)mg,t=-4.818,P=0.000］,吸氧时间短［(3.8±2.0)d vs (51±2.6)d,t=-2.171,P=0.034］,动脉血氧饱和度高［(97.6±2.7)% vs (96.1±2.7)%,t=2.152,P=0.036］。2组清扫胸腔淋巴结组数(1.87±0.43 vs 1.93±0.37,t=-0.579,P=0.565),清扫腹腔淋巴结组数(4.00±0.45 vs 3.97±0.49,t=0.247,P=0.806),术后住院时间［(11.8±1.0)d vs (12.0±1.2)d,t=-0.701,P=0.486］,肺感染(2 vs 5, χ2=0.647,P=0421),心房纤颤(2 vs 4, χ2=0.185,P=0.667)及切缘阳性(0 vs 1, χ2=0.000,P=1.000)无显著差异。随访时间［(36.3±139)月 vs (36.3±16.5)月,t=0.024,P=0.981］,1年生存(19 vs 22, χ2=0.487,P=0.485),3年生存(10 vs 12, χ2=0.194,P=0.660)及胸痛(2 vs 3, χ2=0.000,P=1.000)2组无显著差异。结论经胸腹联合小切口手术创伤小，有利于肿瘤的完整切除，是一个理想的手术入路。
Abstract:
ObjectiveTo investigate the efficacy of thoracoabdominal miniincision surgery for the treatment of gastric cardia cancer.MethodsRadical resection of gastric cardia cancer was performed on 60 patients from January 2002 to January 2007. Thoracoabdominal miniincision was used in 30 cases, and posterolateral thoracotomy was carried out in the other 30 patients. The data of the two groups were retrospectively analyzed.ResultsThe operations were accomplished without death or severe complications in all the patients. Compared with the posterolateral thoracotomy group, thoracoabdominal miniincision group had shorter incisions ［(124±0.7) cm vs (19.2±2.0) cm, t=-17577, P=0.000］, shorter operation time ［(207.3±76.1) min vs (260.0±856) min, t=-2.519, P=0.015］, earlier postoperative ambulation ［(2.3±0.5)d vs (3.4±0.5) d, t=-8.521, P=0000］, less thoracic drainage ［(276.7±58.7) ml vs (308.7±59.5) ml, t=-2.097, P=0.040］, less analgesic (pethidine) requirement ［(66.7±27.3) mg vs (113.3±45.4) mg, t=-4.818, P=0.000］, shorter duration of oxygen use ［(38±2.0) d vs (5.1±26) d, t=-2.171, P=0.034］, and higher arterial oxygen saturation［(976±27)% vs (961±27)%,t=2152,P=0036］. No significant difference was observed between the two groups in the number of dissected thoracic lymph nodes (1.87±043 vs 1.93±0.37, t=-0.579, P=0565), number of dissected celiac lymph nodes (4.00±0.45 vs 3.97±0.49, t=0.247, P=0806), postoperative hospital stay ［(11.8±1.0) d vs (12.0±1.2) d, t=-0.701, P=0.486), pulmonary infection (2 vs 5, χ2=0.647, P=0.421), atrial fibrillation (2 vs 4, χ2=0185, P=0.667) and positive surgical margins (0 vs 1, χ2=0.000, P=1.000). The two groups were followed up for (36.3±139) months and (36.3±16.5) months, respectively (t=0.024, P=0981), no significant difference was detected between them in the 1 and 3year survival cases (19 vs 22, χ2=0.487, P=0.485; and 10 vs 12, χ2=0.194, P=0.660) and chest pain (2 vs 3, χ2=0.000, P=1.000) during the period.ConclusionsBy using a thoracoabdominal miniincision, gastric cardia cancer can be resected completely with less trauma. The approach is ideal for clinical application.

参考文献/References:

[1]毛伟敏,严福来,吕桂泉,等.贲门癌经胸切除术式的改进.中华普通外科杂志,2001,16(9):575.
[2]Wang LS,Wu CW, Hsieh MI,et al.Lymph node metastasis in patients with adenocarcinoma of gastric cardia.Cancer,1993,71(6):1948-1953.
[3]王振宁,鲁翀,徐惠绵.胃上部癌淋巴结转移规律及其在外科治疗中的应用.中国实用外科杂志,2002,22(10):611-612.
[4]邵钦树,陈学荣,邹寿椿.贲门癌的生物学行为及其在外科治疗中的意义.中华外科杂志,2003,41(10):738-740.
[5]Manzoni G,Pedrazzani C,Pasini F,et al.Results of surgical treatment of adenocarcinoma of the gastric cardia.Ann Thorac Surg,2002,73(4):1035-1040.
[6]王晓新,李宏芹,陈鸿义,等.不同手术径路治疗贲门癌的对比研究.中华外科杂志,2005,43(19):1262-1264.
[7]Meyer W,Popp M,Klinger L,et al.Results of adenocarcinoma of the esophagogastric junction according to a standardized surgical resection technique.Dig Surg,2002,19(4):269-274.
[8]葛孝忠,郑和平,耿仲伟,等.腋下弧形小切口在胸部手术中的应用.中国微创外科杂志,2005,5(8):631-631.
[9]王其彰,张毓德,杜喜群,等.食管癌切除术后胃重建食管的测压观察.中华外科杂志,1988,26(2):305-309.
[10]张卫民,陈克能,张卫华,等.食管、贲门癌不同术式围手术期动脉血气的动态变化及其与术后心肺并发症的关系.中国肿瘤临床与康复,2000,7(2):34-35.

更新日期/Last Update: 2013-10-22