经腹切开膈肌脚纵隔内行食管胃或空肠机械吻合术治疗贲门部癌

目的 探索治疗贲门部癌的手术入路新方法。方法 经腹切开膈肌脚入,用国产吻合器行纵隔内食管胃吻合89例、食管空肠吻合16例。结果 在切除肿瘤及其上方7cm食管的同时，清除纵隔下部淋巴结，淋巴结转移率为20．9％。全组病例无手术死亡，无吻合口瘘，亦无食管切缘癌残留。术后并发症发生率4．76％,5年生存率39％。结论 经腹切开膈肌脚纵隔内食管胃（空肠）机械吻合术，操作简便，术野暴露良好，创伤及生理扰乱较小，能有效地预防吻合口瘘，且便于切除足够长度食管和扩大淋巴结清除范围。适用于浸润食管长度＜2cm的贲门部癌的外科治疗。

Transabdominal intramediastinal esophagastricor esophajejunal anastomosis for t he treatment of cardial carcinoma

Objective To evaluate a new surgical approach for the treatment of carcinoma of the gastric cardia. Methods The GI stapler was used to perform intramediastinal esophagogastrostomy for cardial carcinoma in 89 cases and esophago-jejunostomy in 16 cases undergoing total gastrectomy by the transabdominal approach with incising the crus dextrum of the diaphragm. Results The average length resected of the lower part of the esophagus was over 7 cm. Intramediastinal lymph node metastasis was found by pathology in 209% (22/105).There was no operative mortality and the morbidity rate was 476%, 5 year survival rate was 39%. Conclusions The technique enables lymphadenectomy within the lower mediastinum and a sufficiently long enough resection of the esophagus. Transabdominal incision of the crus dextrum of the diaphragm makes a clear operative field for the purpose of radical operation for carcinoma of the gastric cardia. The anastomosis by GI stapler effectively prevents anastomotic leakage.This procedure is indicated for cardial carcinoma cases in which the esophageal involvement is within 2 cm.