Date R S, Panesar K J S
Department of Surgery, Altnagelvin Area Hospital, Londonderry, UK.
Int J Clin Pract. 2005 Jun;59(6):672-4. doi: 10.1111/j.1742-1241.2004.00413.x.
In the contemporary practice, surgery is the only potentially curative treatment available for gastric cancer. However, there is no consensus on the extent of surgical resection. Advantages of D2 gastrectomy in terms of morbidity, mortality, local recurrence and survival are confirmed in Japanese as well as some European trials. In our hospital, all patients with operable gastric cancer are treated with D2 gastrectomy along with splenectomy and distal pancreatectomy followed by jejunal pouch reconstruction. The study was undertaken to evaluate our practice in terms of postoperative morbidity and mortality. All the patients who had total gastrectomy for gastric carcinoma from January 1995 to December 2000 were included in the study. During this 6-year period, 33 patients underwent potentially curative D2 gastrectomy. Postoperative morbidity and mortality were 18 and 9%, respectively. There were no anastomotic leaks. Three (9%) patients developed dysphasia, of which two (6%) had anastomotic stricture requiring dilatation. We feel D2 gastrectomy with splenectomy and distal pancreatectomy when performed electively is a safe procedure in experienced hands. Oesophago-jejunal anastomosis can be safely performed using circular stapler.
在当代临床实践中，手术是胃癌唯一可能治愈的治疗方法。然而，对于手术切除范围尚无共识。日本以及一些欧洲的试验证实了D2胃切除术在发病率、死亡率、局部复发和生存率方面的优势。在我们医院，所有可手术切除的胃癌患者均接受D2胃切除术，同时行脾切除术和远端胰腺切除术，随后进行空肠袢重建。本研究旨在评估我们在术后发病率和死亡率方面的实践情况。1995年1月至2000年12月期间所有因胃癌接受全胃切除术的患者均纳入本研究。在这6年期间，33例患者接受了可能治愈性的D2胃切除术。术后发病率和死亡率分别为18%和9%。未发生吻合口漏。3例（9%）患者出现吞咽困难，其中2例（6%）有吻合口狭窄需要扩张。我们认为，在经验丰富的医生手中，选择性行D2胃切除术联合脾切除术和远端胰腺切除术是一种安全的手术。使用圆形吻合器可安全地进行食管空肠吻合。
