经腹纵隔内食管胃黏膜吻合术治疗老年贲门癌

目的：探讨老年贲门癌经腹手术的新手术入路及手术方式。方法：经腹切口，使用悬吊拉钩，切开膈肌脚或食管裂孔弓形部，纵隔内应用浆肌瓣覆盖-食管胃黏膜吻合术治疗老年贲门癌178例。其中，根治性切除140例（78．7％）．姑息性切除38例（21．3％），根治术中联合脏器切除18例（10．1％）。对照组老年贲门癌患者170例采用常规经胸手术切除，并行胃食管胸腔吻合。结果：两组所有患者术后均无吻合口漏，切缘均无癌细胞存留，无一例死亡。治疗组术后发生并发症15例（8．4％），对照组术后发生并发症31例（18．2％），两组相比。差异有显著性（P〈0．01）。结论：经腹切开膈肌脚，纵隔内行胃浆肌瓣覆盖一食管胃黏膜吻合术，操作在腹腔进行，创伤及生理干扰较小，可提高手术的安全性．减少老年贲门癌患者术后并发症的发生。

Transabdominal mediastinal approach for mucosa esophago-gastrostomy in aged people with carcinoma of gastric cardia

Objective:To explore the new transabdominal intra-mediastinal operative approach and methods for carcinoma of gastric cardia in aged people.Methods:All the incisions were made at abdominal in all 178 cases.The phrenic roots or esophagus hiatus were incised.The anastomosis of esophagus and stomach were covered by sero-muscular flap of gastric wall,which was the operation of mucosa esophago-gastrostomy.All operations were proximal mostly gastrectomies.The radical operations were performed in 140 cases(78%) ,palliative operations in 38 cases(21.3%) ,and combined with other organs' radical operations in 18 cases(10.1%) .The patients in control group were treated by general operation via thoracic cavity.Results:There were no postoperative leakages of anastomosis,and no cancer cell were left at all the cutting edges.No case died.Postoperative complications appeared in 15 cases(8.42%) and 31 cases(18.2%) respectively,and were of no difference statistically.Conclusion:The transabdominal intra-mediastinal mucosa esophago-gastrectomy is less invasive and influent physiologically.For carcinoma of gastric cardia in aged people,this kind of operation is more safety,and causes less postoperative complications.