Gastric carcinoma and surgery treat history and review _'s treatment

Gastric carcinoma and surgery treat history and review _'s treatment
Surgery's therapeutic development history of gastric carcinoma can be traced back to 1881 years, Billroth was that a gastric carcinoma patient made stomach part and excised the skill for the first time at that time, although the operation succeeds, die from and " recur " shortly after the patient . In 1897, Schlatter achieved and treated gastric carcinoma with the whole gastrectomy. By the forties, a plurality of medical centres adopted the whole gastrectomy as the regular means to treat gastric carcinoma already. Because find the lymphocytic transformation prolonging and lymph node by pancreas upper flange and arteria coeliaca backbone and branch, already a few scholars advocated listing body end of pancreas and spleen in excising the range at that time, emphasize at the same time and dissect along the liver artery, and excise big omentum and stomach colon ligament and stomach together; Seeing that the operation is in extensive range, mortality is up to 50%. The intersection of skill and improvement of aftertreatment with operating technology and in front of the skill, the mortality of operation is reduced to some extent; But because the case was chosen not strict enough, survival rate has not improved notably in five years, to make some surgeons in the fifties and sixties incline to adopt smaller excision range.
Rui Jin hospital launched the research that the expanding excision skill treats gastric carcinoma promptly from middle period of the fifties. In practise, summarize, draw at the beneficial foundation of experience of others constantly at the same time, some views are revised several times too. For example in 1965, expanded lymph node pathology of excising the skill sample to dissect, study according to 24 gastric carcinomas, find progress issues of case shift many to limited to the intersection of focus and neighbouring the intersection of stomach and week lymph node, and can involve, far away from having illness coming on stomach week and deep department lymph node of the cooking stove originally at the same time, namely sinus department cancerous swelling shifts the possibility of lymph node by the cardia, and the cardia department cancerous swelling can also be shifted to the up and down lymph node of pylorus; In addition, the arteria coeliaca bes and mainly takes a root, around the liver artery, behind the pancreas duodenum, around the the intersection of pancreas and the intersection of body and the intersection of tail and the intersection of spleen and artery of upper flange, and spleen the intersection of door,etc. and lymph node of place can have higher positive rate in every the intersection of district and gastric carcinoma. Thought, in order to achieve the goal of effecting a radical cure in gastric carcinoma, should accomplish at that time: 1, Lymph node behind cleaning base of a fruit of liver and pancreas duodenum; 2,Excise body end of pancreas and spleen in order to guarantee removing around the spleen artery and lymph node of door district of spleen at the same time; 3,Clean the lymph nodes of the arteria coeliaca and branched root of base; 4,Make the whole gastrectomy in order to guarantee the clearance of lymph node by the cardia.
In 1982, authors summarized Rui Jin hospital surgery and gastric carcinomas 1 accepted for medical treatment in 1958-1980, 881, have analyzed especially that acts as and expands 685 patients who excises the skill. Through the comparison of survival rate, have made the following conclusion: 1, To early gastric carcinoma, need, make, add, all excise the skill about stomach time that regional lymph node clean only; 2,2, issues of patient should regard as, expand target to effect a radical cure skill; 3, A patient only needs to do corresponding simpler operation according to the circumstances.
1983, author fetch, accord with gastric carcinoma, expand the intersection of operation and 55 of sample to radically treat skill again, consult the intersection of stomach and the intersection of subregion and law and lymph node research association make, gastric carcinoma of Japan, divide into groups law go on research, the conclusion is: 1, Clean the necessity of the lymph node at a distance in a gastric carcinoma to developing; 2,Cardia the intersection of fundus of stomach and the intersection of district and cancer and because the intersection of stomach and the intersection of body and the intersection of district and cancer shift 1-6 rate of lymph node high by stomach, it is difficult to achieve the goal of removing all tumours to organize to excise not to make the whole stomach; 3,In cancer in the sinus district, find the person who gives much trouble lymph node is few by the right of cardia, and the lymph node is negative by the left of cardia, have suspicious lymph node person really by the cardia, only need to implement the near complete gastrectomy; 4,Cancerous swelling of three different areas is apt the lymph node is shifted by spleen door and spleen artery, in order to effect a radical cure, unite gastric carcinoma of spleen and pancreas body end and expand and radically treat the skill imperatively; 5,Support to take the policy of different treatment ways to a case of different diseases again.
In recent years, domestic numerous scholars have gradually unanimous tendencies on view with therapeutic in surgery gastric carcinoma, namely: 1, The surgery is a main means to treat gastric carcinoma; 2,Permit to the intersection of whole body and condition have patient that obvious distant place shift, all should perform the operation, ascertain and strive to make and excise; 3,The operation must radically treat its result in order to accept completely.


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