Mihmanlı Mehmet, Köksal Hakan Mustafa, Demir Uygar, Işıl Rıza Gürhan
Clinic of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
Ulus Cerrahi Derg. 2015 Jun 24;32(1):47-9. doi: 10.5152/UCD.2015.2817. eCollection 2016.
The esophago-gastric junction may be challenging during total gastrectomy due to gastric cancer. This situation may compromise the security of both the dissection and anastomosis. The purpose of this study was to investigate the usefulness of xiphoidectomy to overcome this issue.
The files of patients who underwent total gastrectomy + D2 lymph node dissection due to proximal gastric cancer or cardia cancer between April 2002-December 2013 were retrospectively evaluated. We assessed the outcome in patients with xiphoidectomy in addition to the midline incision in terms of xiphoidectomy technique, xiphoidectomy time, and operative and postoperative complications.
Thirty cases were identified to undergo xiphoidectomy. Nineteen patients were male and 11 were female, with a mean age of 51 (21-80) years. The time required for xiphoidectomy was 7-15 minutes (mean 8.7 minutes). The mean additional time required for the closure of the incision in cases with xiphoidectomy was 2 minutes. There was minimal arterial bleeding from the diaphragmatic surface in one patient, which was controlled by electrocautery. Only two patients developed wound infection.
Performing xiphoidectomy is quite easy, after a certain learning phase. The operative time was 7-15 minutes longer due to excision of xiphoid and closure of the related defect. Minor hemorrhage was a problem during surgery. There were no early or late post-operative complications. We suggest that the procedure is beneficial in selected cases with requirement of a wider operative field or better exposure of the esophago-gastric junction during total gastrectomy for gastric cancer, and recommend removal of the xiphoid bone.
由于胃癌进行全胃切除术时，食管胃交界部的处理可能具有挑战性。这种情况可能会影响解剖和吻合的安全性。本研究的目的是探讨剑突切除术在克服这一问题上的实用性。
回顾性评估2002年4月至2013年12月期间因近端胃癌或贲门癌接受全胃切除术+D2淋巴结清扫术的患者病历。我们评估了除中线切口外还进行剑突切除术的患者在剑突切除技术、剑突切除时间以及手术和术后并发症方面的结果。
确定30例患者接受剑突切除术。男性19例，女性11例，平均年龄51（21 - 80）岁。剑突切除所需时间为7 - 15分钟（平均8.7分钟）。剑突切除术患者切口闭合所需的平均额外时间为2分钟。1例患者膈面有少量动脉出血，通过电灼控制。仅2例患者发生伤口感染。
经过一定的学习阶段后，进行剑突切除术相当容易。由于切除剑突和闭合相关缺损，手术时间延长了7 - 15分钟。手术中轻微出血是个问题。无早期或晚期术后并发症。我们建议，对于胃癌全胃切除术中需要更广阔手术视野或更好暴露食管胃交界部的特定病例，该手术是有益的，并建议切除剑突骨。
