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作者1990年以来收治48例复发胃癌再次剖腹,30例(63%)为术后3年内的近期复发。复发方式以残胃及吻合口局部复发(45/48,94%)为多,其次为腹腔播散。邻接脏器受侵率高,29例共48例次有肝、横结肠及胰腺等脏器受累。全组共12例发生了22例次并发症。全组手术死亡率12.5%,切除组为8.7%。作者指出,提高胃癌手术的根治度是预防复发的根本措施,不失时机对所有怀疑复发者行剖腹探查是提高复发癌切除率的关键。为减少胰头及肝十二指肠韧带受侵的机会,胃癌切除后的重建以结肠前胃空肠吻合为宜。
Since 1990, the authors treated 48 patients with recurrent gastric cancer and had a re-elevation, and 30 patients (63%) had a recent recurrence within 3 years after surgery. The recurrence pattern was mostly recurrent in the residual stomach and anastomosis (45/48, 94%), followed by dissemination in the abdominal cavity. The invasion rate of adjacent organs was high. In 29 cases, there were 48 cases with liver, transverse colon and pancreas. A total of 12 cases in the whole group had 22 complications. The operative mortality rate was 12.5% in the whole group and 8.7% in the resection group. The authors pointed out that to improve radical surgery for gastric cancer is a fundamental measure to prevent recurrence, and the opportunity to carry out exploratory laparotomy for all suspected relapsers is the key to improving the resection rate of recurrent cancer. In order to reduce the chance of pancreatic head and hepatoduodenal ligament being invaded, reconstruction of gastric cancer after resection is preferably preceded by anastomotic gastrojejunostomy.