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目的 探讨贲门癌术后吻合口复发外科再治疗的手术指征及术式选择。 方法 对2 3例贲门癌术后吻合口复发 ,再手术患者的临床资料进行回顾性分析。 结果 本组患者的手术切除率、手术并发症发生率及手术病死率分别为 6 9 6 %、17 4%和 8 7% ,胸、腹腔粘连率为 87 0 %。肿瘤切除患者平均术后存活 15 0个月 ,明显长于未切除患者的 4 1个月 (P <0 0 5 )。无淋巴结转移患者术后存活 2 1 3个月 ,虽较有淋巴结转移患者的 10 2个月长 ,但差异无显著性意义 (P >0 0 5 )。根治性切除和姑息性切除患者的术后生存期分别为 15 8个月和 13 3个月 ,差异无显著性意义 (P >0 0 5 )。 结论 由于胸、腹腔的广泛粘连及二次手术后的消化道重建 ,贲门癌术后吻合口复发再手术有一定难度 ,手术风险较大 ,加之贲门癌患者本身预后较差 ,因此应严格把握手术指征。术式选择应根据患者病变的分期、分级等具体情况而定。
Objective To investigate the surgical indications and surgical options for reoperation of anastomotic recurrence after cardiac cancer surgery. Methods A retrospective analysis was performed on the clinical data of 23 patients with recurrent cardiac anastomosis after cardiac cancer surgery. Results The surgical resection rate, the incidence rate of surgical complications and the mortality rate of operation in this group were 696%, 174% and 87%, respectively. The thoracic and abdominal adhesion rate was 87%. The mean postoperative survival of patients with tumor resection was 150 months, which was significantly longer than that of patients who did not undergo resection (P < 0.05). The survival rate of patients without lymph node metastasis was 213 months, although it was longer than that of patients with lymph node metastasis (102 months), but the difference was not significant (P > 0.05). The postoperative survival of patients with radical resection and palliative resection was 158 months and 13 months, respectively, with no significant difference (P > 0.05). Conclusion Because of extensive thoracic and abdominal adhesions and reconstruction of the digestive tract after the second operation, reoperation of the anastomotic stoma after cardiac cancer surgery is difficult, the surgical risk is high, and the prognosis of patients with cardiac cancer is poor. Therefore, strict surgical management should be performed. Indications. The choice of surgical procedure should be based on the specific circumstances of the stage, grade, etc. of the patient’s disease.