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目的探讨治疗贲门癌合理的手术径路。方法回顾性收集15年间在我科开胸治疗贲门癌患者527例,非开胸治疗贲门癌患者244例,并对两组术前特征、肿瘤部位、术后并发症及预后进行对比分析。结果非开胸组高龄患者及术前伴发病居多(P<0.01),上切缘癌阳性率、SiewertⅢ型及全胃切除率比例高(P<0.05),开胸组术后心肺并发症发生率高于非开胸组(P<0.01),术后平均住院时间长,SiewerⅠt型、Ⅱ型比例高(P<0.05),两组平均手术时间、手术根治率及1,3,5年生存率差异均无显著性(P>0.05)。结论两种径路各有其优缺点,应依据S iewert分型及患者体质进行个性化治疗。
Objective To investigate the reasonable operation path of cardia cancer. Methods Retrospectively collected 527 patients with cardia cancer who underwent thoracotomy in our department during 15 years and 244 patients who underwent non-thoracotomy for cardia cancer. The preoperative characteristics, tumor location, postoperative complications and prognosis were compared between the two groups. Results The majority of patients in the non-thoracotomy group had the most preoperative complication (P <0.01), the positive rates of the resected margin cancer, the high rate of Siewert Ⅲ type and total gastrectomy (P <0.05), and postoperative cardiopulmonary complications (P <0.01). The average postoperative hospital stay was longer, and the ratio of Siewer Ⅰt and Ⅱ was higher (P <0.05). The average operation time, radical cure rate and 1,3,5 year survival rate No significant difference (P> 0.05). Conclusion Both pathways have their own advantages and disadvantages, and should be personalized according to S iewert classification and patient’s physique.