摘要目的 探讨经腹经后纵隔进行贲门癌根治的可行性和安全性.方法 对26例贲门癌侵及食管下段的患者进行经腹经后纵隔贲门癌根治术,其中根治性近端胃食管切除9例,根治性全胃食管切除17例.结果 本组26例均成功完成经腹经后纵隔贲门癌根治术.平均手术时间:全胃切除(189±39)min,近端胃切除(153±35)min;平均手术出血量:全胃切除(200±80)ml,近端胃切除(168±76)ml;平均清扫淋巴结数:腹腔淋巴结(23.3±7.3)枚/例,食管旁淋巴结(4.1±2.0)枚/例.术后无吻合口出血、吻合口瘘、吻合口狭窄发生,4例患者出现肺部感染,经治疗好转,所有患者恢复良好.术后随访5～51个月,4例出现肝转移,2例发生肺转移,其中1例死亡,其余患者情况良好,无吻合口癌复发.结论 经腹经后纵隔贲门癌根治术安全、可行,适用于膈肌没有受侵犯、食管受侵小于5 cm的胃上都癌.

abstractsObjective To investigate the feasibility and safety of transabdominal perposterior mediastinum radical operation in the treatment of cardiac carcinoma. Methods Twenty-six cases of cardiac carcinoma invading low esophagus underwent transabdominal posterior mediastinum radical resection. Among them 9 patients received radical proximal gastroesophagectomy, and 17 cases did radical total gastroesophagectomy. Results The procedures were all successful. The mean operation time for total gastrectomy was (189±39) min, proximal subtotal gastrectomy was (153±35) min. The averge blood loss of total gastrectomy was (200±80) ml, proximal subtotal gastrectomy was (168±76) ml. The harvest of celiac lymph nodes were (23.3±7.3), esophageal lymph nodes were (4.1±2.0). Pneumonia was complicated in 4 cases and there was no anastomotic hemorrhage, leakage nor stenosis. All patients were followed up from 5 to 51 months, liver metastasis was found in 4 cases, lung metastasis in 2 patients and death in 1. There was no anastomotic stoma tumor recurrence. Conclusion It was feasible and safe to perform transabdominal perposterior mediastinum radical operation for cardiac carcinoma patients, provided that diaphragms was not involved and tumor invaded esophageal length was less than 5 cm.