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空肠间置术预防贲门癌术后反流性食管炎

目的探讨贲门癌近端胃切除空肠间置术后预防反流性食管炎的效果. 方法贲门癌近端胃切除空肠间置术患者,于术后作胃镜和消化道 X线钡餐造影,48例患者于术后7天和2～3个月行连续24小时pH值监测,以评价食管反流的情况. 结果 6例术后出现反流性食管炎,发生率9.68%. 结论采用空肠间置术行消化道重建对预防贲门癌术后反流性食管炎具有良好的临床效果.

Application of Round Stapler for Anterior Resection of Gastric Fundus and Cardia Cancer in Elderly Patients

目的 探讨圆形吻合器在高龄贲门胃底癌经腹切除术中的应用。方法 回顾性分析1999年1月至2009年5月期间在我院接受圆形吻合器经腹切除术的238例70岁以上高龄贲门胃底癌患者的临床资料，并对围手术期结果进行分析。 结果 全组手术时间3～4.5 h，平均3.5 h。出血量50～1 000 ml，平均300 ml。术中并发大出血1例，给予积极止血，无术中死亡。所有病例机械吻合术后未出现吻合口漏。术后60例患者（25%）出现不同程度的并发症，其中吻合口出血2例, 左侧胸腔积液13例，肺部感染15例, 心衰3例, 肺不张2例, 心律失常10例，右侧胸腔积液15例。无围手术期死亡。术后随访3年，出现返流性食管炎45例，吻合口狭窄30例，无吻合口肿瘤复发，3年生存率为64%(152/238)。结论 应用圆形吻合器在高龄胃底贲门癌患者经腹切除术是安全、有效的。

贲门癌手术对胆囊收缩功能的影响

目的 研究贲门癌患者围手术期对胆囊功能的影响，减少术后消化道并发症。方法 将82例贲门癌患者按手术中是否保留迷走神经,分为两组,Ⅰ组(n＝65): 手术中未保留迷走神经;Ⅱ组(n＝17): 手术中保留迷走神经。用B型超声波测量胆囊容积、胆囊收缩功能，并进行手术前后自身对照和两种术式的对比研究。结果 Ⅰ组胆囊容积、收缩功能术前与术后比较差别具有显著性意义（P＜0.01），Ⅱ组改变不明显（P＞0.05）;术后胆囊容积两组比较差别具有显著性意义（P＜0.01）；Ⅰ组患者术后消化道症状明显,胆囊结石发生明显增多。结论 保留迷走神经干的贲门癌切除术有利于患者术后的胆囊功能恢复和提高生活质量。

贲门癌术后吻合口复发癌的再手术治疗

目的 探讨贲门癌术后吻合口复发癌再手术的可能性和适应证. 方法 再次手术采用胸腹联合切口和左胸切口,手术切除9例,术中姑息性置管2例,探查3例. 结果 术后发生严重并发症2例,无手术及院内死亡.手术切除者中2年和3年生存率分别为44.4%(4/9)和22.2%(2/9),5例分别在7个月～2年内死亡,2例失访.置管及探查者均在2～7个月内死亡. 结论 贲门癌术后吻合口复发癌再手术要求较高,须严格掌握手术适应证.如患者一般情况较好,病灶较小,无远处转移,仍可再次积极手术,尤其是首次经腹手术者为佳.

Clinical features and treatment of pancreatic metastasis from cardiac carcinoma (a case report)

ObjectiveTo investigate clinical features and treatment of pancreatic metastasis from cardiac carcinoma.MethodsThe clinicopathological data of a patient with pancreatic metastasis from cardiac carcinoma in the General Hospital of Western Theater Command were retrospectively analyzed. The results of multi-disciplinary treatment (MDT) of this case were summarized.ResultsThe imaging findings of abdomen CT of this patient were that the solid occupying position of the head of pancreas was considered as a new organism. After discussing by the MDT and exclusing operative contraindications, the radical resection of cardiac cancer with pancreaticoduodenectomy and enlarged intraperitoneal lymph node dissection was performed under the general anesthesia. The operation was smooth and the bleeding was about 600 mL. The patient recovered well after the operation and had no serious complications. The patient was discharged on day 10 after the operation. The results of postoperative pathological diagnosis were the cardiac carcinoma with pancreatic head implantation metastasis (stage Ⅱ A, T3M0N0); obstructive jaundice, liver damage, extrahepatic and extrahepatic biliary dilatation. The patient received the intravenous infusion of the oxaliplatin pluse tigualone for 4 courses. The patient was generally in a good condition and had survived 5 months free tumor. The CA19-9 level was 45.6 U/mL (it was 449.60 U/mL before the operation).ConclusionsPancreatic metastasis from cardiac carcinoma is rare and need to be distinguished from primary pancreatic cancer. Survival time is short and prognosis is poor. Clinical symptoms are improved and survival time is prolonged after operation with postoperative chemotherapy.

食管、贲门癌术后胸胃排空障碍14例

目的 探讨食管、贲门癌术后胸胃排空障碍的治疗措施,以提高术后胸胃排空障碍的疗效。 方法 14例食管、贲门癌术后发生胸胃排空障碍患者中有3例给予保守治疗，11例经保守治疗效果不佳者在胃镜下安置鼻空肠营养管行肠内营养支持治疗，其中2例仍无效者行剖腹探查，幽门成形加空肠造瘘术。 结果 所有患者全部康复，其中3例经保守治疗1周治愈；11例在胃镜下安置鼻空肠营养管给予肠内营养治疗者中有9例于2周内拔除胃管，恢复正常饮食，2例行幽门成形加空肠造瘘术，术后2周治愈出院。所有患者随访3~6个月，进普通食物无恶心、呕吐。消化道X线钡餐检查显示：吞服钡剂后胸胃无钡剂潴留和明显扩张。 结论 在胃镜下安置鼻空肠营养管给予肠内营养是治疗胸胃排空障碍的一种有效方法，且安全可靠、方便经济；对疗效欠佳的患者，宜尽早行剖腹探查加幽门成形术。

Clinical Application of Trans abdominal Operation in Cardiac Cancer

目的:探讨不同手术入路在贲门癌治疗中的临床应用。方法:回顾性分析我院2003年8月至2009年1月期间收治的153例贲门癌患者的临床资料,根据不同手术入路分为经腹组(n=74)、胸腹联合组(n=27)和经胸组(n=52),对3组患者的手术中、术后恢复情况以及随访结果进行对比分析。结果:手术切除率100%,围手术期无死亡病例。经腹组手术时间短于经胸组和胸腹联合组,术中出血量也少于经胸组和胸腹联合组,但差异无统计学意义(Pgt;0.05)。胸腹联合组和经腹组清扫的淋巴结数目明显多于经胸组,差异有统计学意义(Plt;0.05)。经腹组患者术后住院时间和术后并发症发生率明显少于胸腹联合组和经胸组,差异有统计学意义(Plt;0.05)。3组患者的术后局部复发率和远处转移率的差异均无统计学意义(Pgt;0.05),3年和5年生存率的差异也无统计学意义(Pgt;0.05)。结论:经腹贲门癌切除术是安全和有效的,配合吻合器的使用,操作也是可行的。

Evaluation of Lymph Node Metastasis Features of Abdominal Esophageal Carcinomas and Cardiac Cancer by Multi-Detector Spiral CT

ObjectiveTo explore the differences and similarities of the featurs of lymph node metatasis of abdominal esophageal carcinoma and cardiac cancer. MethodsPreoperative CT images of abdominal esophageal carcinomas and cardiac cancers were reviewed and analysed on lymph node size and preponderant distribution. ResultsShort diameter ≥10 mm of lymph node at CT was adopted as metastasis criterion. The detection rates of abdominal esophageal carcinomas and cardiac cancers were 73.5%（144/196） and 83.7% （170/203）, respectively. Thoracic lymph node metastasis rate of abdominal esophageal carcinomas was 11.1% （4/36） in 7 area, 27.8% （10/36） in 8 area, 8.3% （3/36） in 9 area, while celiac lymph node metastasis rate was 36.1% (13/36 ） in No.7 group, 19.4% （7/36） in No.1 group, and 11.1% （4/36） in No.2 group primarily. Lymph node metastasis rate of cardiac cancers was 17.9% （5/28） in No.1 group, 28.6% （8/28） in No.2 group, 39.3% （11/28 ） in No.3 group, and 25.0% （7/28） in No.4 group for the first stop lymph nodes, and 35.7% （10/28 ） in No.7 group for the second stop primarily. ConclusionAs metastasis criterion, short diameter ≥10 mm of lymph node at CT is feasible, but there exist certain falsepositive rate. Thoracic lymph node metastasis of abdominal esophageal carcinomas is mainly in the 7, 8, and 9 area, while celiac metastasis is mainly in No.7, No.1, and No.2 groups. Lymph node metastasis of cardiac cancers is in No.1, No.2, No.3, No.4, and No.7 group primarily.

术前介入化疗对贲门癌患者免疫功能的影响

Diagnosis and Surgical Treatment of Multi-primary Esophageal Carcinoma

Objective To study the diagnosis and surgical treatment of multi-primary esophageal carcinoma. Methods The data of 29 patients of multi-primary esophageal carcinoma were collected .The diagnosis was made by dye-staining through gastroscopy and X-ray examination.Pathological examination after operation was analyzed.Three kinds of operations were used: 22 by radical resection, 5 by partial resection and 2 by surgical exploration. Results Twenty-one patients were diagnosed before operation,8 patients were diagnosed during and after operation. Sixty-seven foci and 6 early stage patients were found. The complications were found in 7 patients.No patient died during operation. Twenty-five patients were followed up. The follow up time was 7-36 months.1-year survival rate 77.8%,3-year survival rate 41.6%. Conclusion Routine X-ray examination of esophagus, and esophageal dye-staining and/or biopsy through endoscopy are important measures for early diagnosis of multi-primary esophageal carcinoma.Prompt surgery is advised.