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目的探讨圆形吻合器在高龄贲门胃底癌经腹切除术中的应用。方法回顾性分析1999年1月至2009年5月期间在我院接受圆形吻合器经腹切除术的238例70岁以上高龄贲门胃底癌患者的临床资料,并对围手术期结果进行分析。结果全组手术时间3～4.5h,平均3.5h。出血量50～1000ml,平均300ml。术中并发大出血1例,给予积极止血,无术中死亡。所有病例机械吻合术后未出现吻合口漏。术后60例患者(25%)出现不同程度的并发症,其中吻合口出血2例,左侧胸腔积液13例,肺部感染15例,心衰3例,肺不张2例,心律失常10例,右侧胸腔积液15例。无围手术期死亡。术后随访3年,出现返流性食管炎45例,吻合口狭窄30例,无吻合口肿瘤复发,3年生存率为64%(152/238)。结论应用圆形吻合器在高龄胃底贲门癌患者经腹切除术是安全、有效的。
Objective To investigate the application of circular stapler in transabdominal resection of advanced gastric cardia carcinoma. Methods The clinical data of 238 patients with gastric cardia carcinoma over the age of 70 from January 1999 to May 2009 in our hospital undergoing transabdominal circular stapler resection were retrospectively analyzed. Results of perioperative period were analyzed . Results The whole operation time of 3 ~ 4.5h, an average of 3.5h. Bleeding volume 50 ~ 1000ml, an average of 300ml. Intraoperative bleeding in 1 case, given a positive hemostasis, no intraoperative death. Anastomotic leakage did not appear after mechanical anastomosis in all cases. Postoperative 60 patients (25%) had different degrees of complications, including anastomotic bleeding in 2 cases, left pleural effusion in 13 cases, pulmonary infection in 15 cases, heart failure in 3 cases, atelectasis in 2 cases, arrhythmia 10 cases, right pleural effusion in 15 cases. No perioperative deaths. After 3 years of follow-up, there were 45 cases of reflux esophagitis, 30 cases of anastomotic stricture, no recurrence of anastomotic tumor, the 3-year survival rate was 64% (152/238). Conclusion The application of circular stapler in the treatment of advanced gastric fundus ablation is safe and effective.