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报道18例晚期胃癌病例行联合脏器切除术的临床经验,指出对晚期病例只要全身情况可耐受较大手术,应积极行根治性联合脏器切除术。可行胃部分或全胃联合脾胰体尾、横结肠及其系膜、肝不规则切除术等,根据淋巴结转移情况选择R_2、R_2~+或R_3手术;远侧胃切除后多采用Roux-Y或毕Ⅱ式吻合,全胃切除后行食管-空肠“P”型加空肠输入“Y”型吻合术。强调围手术期处理的重要性,术前应提高病人对手术的耐受性,术后常规行全胃肠外营养支持,防治胰腺切除后并发症。术前、术后化疗宜根据病人具体情况进行。
The clinical experience of 18 cases of advanced gastric cancer with combined organ resection was reported. It was pointed out that as long as the general condition of advanced cases can tolerate larger operations, radical joint organ resection should be performed actively. Feasible stomach or total stomach combined spleen pancreas body tail, transverse colon and mesentery, liver irregular resection, etc., according to lymph node metastasis choose R2, R2 ~ + or R_3 surgery; after the distal gastrectomy Roux-Y or more Bi-type II anastomosis, after total gastrectomy esophageal-jejunum “P” plus jejunum input “Y” anastomosis. Emphasis on the importance of perioperative management, preoperative patients should improve the tolerance of surgery, postoperative routine total parenteral nutrition support, prevention and treatment of complications after pancreatectomy. Preoperative and postoperative chemotherapy should be based on the specific circumstances of the patient.