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晚期胃癌的手术治疗,过去多以姑息性手未为主,联合脏器切除的应用,目前尚有不同意见。本文报导18例晚期病例行联合脏器切除术,无手术死亡,无严重并发症,生存期延长,为进一步综合治疗创造了条件。指出对晚期病例应分为有根治可能和无根治可能两组,有根治可能者,只要全身情况可耐受较大手术,应积极行根治性联合脏器切除术。并阐述了根据胃部癌肿部位及病变范围,直接侵犯临近器官及淋巴转移情况等几个方面选择具体的手术切除方式,可行胃部分或全胃联合脾胰体尾、横结肠及其系膜、肝不规则切除术等,根据淋巴结转移情况选择R_2、R_2~+或R_3手术;强调远侧胃切除后多采用Roux-y或毕Ⅰ式吻合,全胃切除后行食管一空肠“P”型加空肠输出入“Y”型吻合术。强调围手术期处理的重要性,术前应提高病人对手术的耐受性,术后常规行全胃肠外营养支持,防治胰腺切除后并发症。术前,术中,术后化疗宜根据病人具体情况进行。
Surgical treatment of advanced gastric cancer, in the past mostly palliative hand-based, combined organ resection applications, there are still different views. This article reports 18 cases of advanced organ surgery combined organ resection, no operative death, no serious complications, prolonged survival, to create conditions for further comprehensive treatment. It is pointed out that the late cases should be divided into two groups with possibility of radical treatment and no radical treatment. If there is a possibility of radical treatment, as long as the general condition can tolerate the larger operation, radical joint organ resection should be performed actively. In addition, specific surgical resection methods were selected according to the site of cancer and the extent of lesions in the stomach, direct invasion of adjacent organs and lymphatic metastasis, etc., and feasible stomach or total stomach combined with spleno-pancreatic body tail, transverse colon and mesentery, Liver irregular resection, etc., according to the lymph node metastasis choose R2, R2 ~ + or R_3 surgery; emphasis on the use of Roux-y or Bi I after anastomosis after distal gastrectomy, a total gastrectomy after the esophageal jejunum “P” type Plus intestine output into the “Y” type of anastomosis. Emphasis on the importance of perioperative management, preoperative patients should improve the tolerance of surgery, postoperative routine total parenteral nutrition support, prevention and treatment of complications after pancreatectomy. Preoperative, intraoperative, and postoperative chemotherapy should be performed according to the specific conditions of the patient.