【摘要】 目的　探讨进展期胃上部癌施行根治性切除和消化道重建的术式和治疗效果。方法　随访 1993～ 1996年完成的胃上部癌全胃切除 ,食管 -空肠Roux en Y吻合术患者共 46例 ,并分析其临床资料。结果　 46例进展期胃上部癌施行全胃切除D2 ,D2 + 根治 ,食管 -空肠Roux en Y重建术者术后均存活 ,3 8例获 1～ 7年长期随访 ,1,3 ,5年生存率分别为 86.8% (3 3例 )、63 .2 % (2 4例 )和 42 .1% (16例 )。生存 5年至今的 14例中 ,有上腹疼痛、饱胀 4例 ,反流性食管炎 1例 ,慢性营养不良 2例 ,7例存活时间超过 6年。结论　对进展期胃上部癌施行全胃切除D2 ,D2 + 根治并食管 -空肠Roux en Y重建消化道 ,淋巴结清除完全 ,并发症有所降低。如能规范适应证的选择和手术操作 ,术后 5年生存率可望提高更多还原

【Abstract】 Objective To study the effect of total gastrectomy with Roux en Y anastomosis on upper portion carcinoma of stomach (UPCS). Methods The clinical data of 46 cases of UPCS undergoing total gastrectomy with Roux en Y anastomosis were analysed. Results The total gastrectomy D 2 or D 2 + procedure with Roux en Y anastomosis was performed in 46 patients, all patients alive after operation. 38 cases were followed up. After operation, l, 3 and 5 years survival rate was 86.6% (33 cases), 63%(24 cases) and 42%(16 cases) ,respectively.Of 14 living patients, 4 had gastric emptying disturbance, 1 reflux esophagitis,and 2 dystrophy. Of the 14 patients, 7 survived>6 years. Conclusions The total gastrectomy D 2 or D 2 + with Roux en Y anastomisis procedure for the upper portion carcinoma of stomach can resect the lymph nodes completely, and postoperative complications are reduced. If the indications and techniques could be standerized, the postoperative 5 years survival rate might be increased.更多还原