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背景与目的:贲门癌的发病率逐年增高,对其研究逐渐深入,但在临床上还有很多争论。本文总结我们在贲门癌临床外科治疗中的经验。方法:123例手术治疗的贲门癌患者:经胸手术组72例,经腹手术组40例,胸腹联合手术组11例,分析术前检查(腹部B超、胸腹CT、内镜和上消化道造影)、手术入路、淋巴结清扫和术后病理情况。结果:腹部B超对浆膜受侵、淋巴结转移、下段食管受侵、肝转移病变外侵腹水的判断与术后病理的符合率分别达到了71.2%、62.2%、47.8%、100%,胸腹CT则为78.6%、72.7%、51.9%、100%,内镜指示肿瘤距门齿的长度,上消化道造影则显示肿瘤与膈肌的关系。手术切除率94.3%(116/123),116例切除病例中,贲门腺癌108例,占93.1%,腺鳞癌、鳞癌、不典型类癌、类癌各2例,占6.9%,84例腹腔淋巴结转移(72.4%),6例胸腔淋巴结转移(7.1%),40例(34.5%)下段食管受侵。结论:术前腹部B超和胸腹CT检查对判断肿瘤切除有极大帮助,内镜和上消化道造影有助于判断是否开胸。淋巴结转移以腹腔为主。三种手术途径各有优劣,没有任何一种占绝对优势,要依托Siewert分型,因病而定、因人而异。
BACKGROUND & OBJECTIVE: The incidence of cardiac cancer has been increasing year by year, and its research has been gradually deepened. However, there are still many controversies in clinical practice. This article summarizes our experience in clinical surgical treatment of cardia cancer. Methods: One hundred and twenty-three patients with cardiac cancer underwent surgery: 72 cases of transthoracic surgery group, 40 cases of transabdominal surgery group and 11 cases of thoracoabdominal surgery group. The patients underwent preoperative examination (abdominal ultrasound, chest CT, endoscopy and upper Gastrointestinal angiography), surgical approach, lymph node dissection and postoperative pathology. Results: The coincidence rates of abdominal B ultrasound on serosa invasion, lymph node metastasis, lower esophageal invasion and liver metastasis ascites were 71.2%, 62.2%, 47.8%, 100%, respectively Abdominal CT was 78.6%, 72.7%, 51.9%, 100%. Endoscopy indicated the length of the tumor from the incisors. Upper gastrointestinal angiography showed the relationship between the tumor and the diaphragm. Surgical resection rate was 94.3% (116/123). Of the 116 resected cases, 108 were cardiac adenocarcinomas (93.1%), 2 were adenosquamous carcinomas, squamous carcinomas, atypical carcinoids and carcinoid carcinomas, accounting for 6.9%, 84 Cases of abdominal lymph node metastasis (72.4%), 6 cases of thoracic lymph node metastasis (7.1%), 40 cases (34.5%) lower esophageal invasion. Conclusion: Preoperative abdominal B ultrasound and chest X-ray CT examination to determine the tumor resection have great help, endoscopy and upper gastrointestinal imaging can help determine whether the thoracotomy. Lymph node metastasis to the abdominal cavity. There are advantages and disadvantages of the three surgical approaches, there is no absolute advantage of any kind, to rely on Siewert type, depending on the disease may vary.