Wayman J, Dresner S M, Raimes S A, Griffin S M
Northern Oesophago-Gastric Cancer Unit, Cumberland Infirmary, Carlisle and Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Br J Surg. 1999 Apr;86(4):536-40. doi: 10.1046/j.1365-2168.1999.01043.x.
A thoracoabdominal approach has traditionally been described for the resection of tumours of the gastric cardia. The aim of this study was to evaluate a transhiatal approach for resection of cancers of the gastric cardia.
Twenty consecutive patients undergoing transhiatal gastro-oesophagectomy for cancer of the gastric cardia were studied. Data were collected prospectively with regard to operating time, operative blood loss, intensive care unit (ICU) stay, analgesia use, duration of hospital stay, and pathological details of resection margin clearance and lymph node yield. Results were compared with those of the 20 preceding patients for whom the same prospective information had been recorded following resection via the standard thoracoabdominal approach.
The transhiatal approach required a shorter operating time (median 190 (range 105-255) versus 280 (225-330) min; P = 0.004). It resulted in less blood loss (median 405 (180-2000) versus 1000 (420-3200) ml; P = 0.03) and fewer days in the ICU (median 0 (0-31) versus 2 (1-8) days; P = 0.005) despite being performed in an older patient population (median 71 (43-78) versus 63 (59-70) years; P = 0.016). There was no difference in either the lymph node harvest or length or involvement of upper resection margins.
The transhiatal approach to the resection of tumours at the gastric cardia is a valid and safe alternative to the standard thoracoabdominal technique. This technique avoids thoracotomy and its associated morbidity and is accompanied by reduced blood loss, decreased operating time and a shorter ICU stay.
传统上描述采用胸腹联合入路来切除贲门部肿瘤。本研究的目的是评估经裂孔入路切除贲门癌的效果。
对连续20例行经裂孔贲门癌胃食管切除术的患者进行研究。前瞻性收集关于手术时间、术中失血、重症监护病房（ICU）住院时间、镇痛药物使用、住院时间以及切缘清除和淋巴结获取的病理细节等数据。将结果与前20例经标准胸腹联合入路切除术后记录了相同前瞻性信息的患者进行比较。
经裂孔入路所需手术时间较短（中位数190（范围105 - 255）分钟对280（225 - 330）分钟；P = 0.004）。尽管手术对象为年龄更大的患者群体（中位数71（43 - 78）岁对63（59 - 70）岁；P = 0.016），但该入路导致的失血量更少（中位数405（180 - 2000）毫升对1000（420 - 3200）毫升；P = 0.03），在ICU的住院天数也更少（中位数0（0 - 31）天对2（1 - 8）天；P = 0.005）。淋巴结获取数量、上切缘长度或受累情况均无差异。
经裂孔入路切除贲门部肿瘤是标准胸腹联合技术的一种有效且安全的替代方法。该技术避免了开胸及其相关并发症，同时伴有失血量减少、手术时间缩短和ICU住院时间缩短。
