Gastric carcinoma radically treats the relevant rudimentary knowledge _'s treatment of the skill

Gastric carcinoma radically treats the relevant rudimentary knowledge _'s treatment of the skill
The domestic and foreign scholar has further investigated basic issues concerned such as gastric carcinoma and soaking depth, lymphocytic transformation, biological characteristic,etc. in recent years, in addition the development in new technologies such as gastroscope, Ultrasonography B, CT,etc., make early gastric carcinoma and diagnosis rate which develops a gastric carcinoma greatly improve, the operation mortality that the effecting a radical cure stomach part excises skill and the whole gastrectomy is dropped to under 5%, it is reduced that complication has already been seen, survival rate has already been obviously improved too in five years.
Gastric carcinoma radically treats the skill and excises the range and skill type already standardization day by day. It is clear day by day too that the operation adapts to the card. Cooperate according to national gastric carcinoma group consult stipulations, gastric carcinoma of Japan, radically treat gastric carcinoma skill divide into, radically treat the intersection of formula and (R1) , radically treating 2 (R2) With radically treating formula (R3) Three kinds of basic skill types. To some early gastric carcinomas, pathological change is limited to the mucomembranous floor, make R1 operation, removes for stomach week the first stop lymph node can reach, treat, demand. As to generally carrying on a gastric carcinoma, R2 operation can be regarded as the basic skill type, must remove the second stop lymph node. Has already had gastric carcinoma that the third stop lymph node has shifted to some, should construct R3 and radically treat the skill in order to strive for the relativity and cures excising. What is called gastric carcinoma radically treats the skill, its effecting a radical cure is also comparatively speaking, factors such as the depending on gastric carcinoma by stages, sick position, shifting, biological characteristic of lymph node of its result,etc.. So the operation skill type is chosen in view of the above. According to reporting both at home and abroad, expanding and radically treating the skill obtains better curative effect in recent years, radical cure nature the whole gastrectomy based on R3 or unite the internal organs, excise skill, have already caused people's attention day by day.
[Adapt to the card ]
The main adaptation card that gastric carcinoma is excised by the whole stomach:
1.Cooperate phased law of group according to national gastric carcinoma, belong to 2, top (C district) of issue With the middle part (M district) And the underpart (A district) Gastric carcinoma is invaded and body person of stomach (AM) .
2.Range wide stomach shallow in table for lymph node filling the air type or distribute more scattered in multi-oven gastric carcinomas early, should do the whole gastrectomy including the first, 2 stations of lymph nodes.
3.Because walk in benign disease the stomach part excise postoperative incomplete gastric carcinoma.
4.Lymphosarcoma of stomach and smooth muscle tumor of the stomach.
5. Zollinger-Ellison at present been for the most common one except gastric carcinoma in syndrome.
[Postoperative complication and prevention and cure ]
1.It is that a stomach excises one kind of postoperative serious complications that the identical mouth leaks this, happen on postoperative about 7 days more. Strict aseptic technology, careful operation, guarantee the unobstructed and good blood supplt of identical mouth. , postoperative abundant nutrition supplement ago and the skill, it is the key of preventing the identical mouth from leaking. It is the physical sign of peritonitis that the identical mouth leaks the sign taking place and are infected with symptom all over. It handles principles to be competent abdominal cavity guide in time, control, infect, fasting and vein supply nutrition. After dealing with in time, the general pleuripotent heals by oneself.
2.Backflow esophagitis this alkaline intestinal juice, the intersection of gallbladder and liquid and against flow to inflammation nature that oesophageal underpart cause, react pancreatic juice, burn and ache and can't take food behind being shown as the brestbone. The treatment method relies mainly on solving convulsion and stopping the pain and reducing humorally and secreting. Jejunum input and it outputs Pan to be identical or jejunum takes the place of the intersection of stomach and skill, can also prevent from this complication in side.
3.Identical mouth narrow to take place in oesophageal the intersection of underpart and identical port more, besides operating the technical reason, still relate to backflow esophagitis. Narrow slightly can implement and expand and treat; Should perform the operation again while being getting narrow seriously, excise narrow department, again identical, remove the intersection of digestive juice and factor of backflow at the same time.
4.After the malnutritive and anaemia complete stomach is excised, the food is emptied and accelerated, influence and digest and assimilate, lead to the fact the malnutritive and inner factor is scarce, it is the reason to cause anaemia, can supplement vitamin B12 and other nutriment treatments. The prevention method can try hard to adopt and keep near complete gastrectomy that some coats of the stomach organize or take the place of the stomach skill.
[Enclose ] near complete gastrectomy
When it is carried far that early gastric carcinoma and tumour lie in the sinus department or body department, can adopt and keep the stomach bottom, excise the stomach and carry 80%- 90% of the near complete gastrectomy far. Can in cut off coat of the stomach from the intersection of tumour and beyond the intersection of 5cm and, stay 10%- 20% light parts of the intersection of stomach and the intersection of bottom and coat of the stomach organize, also can be in order to reduce the mortality of operation, prevent and reduce postoperative anaemia and keep nutrition bringing the advantage, but postoperative survival rate is not lower than the whole gastrectomy. So should know strictly the operation adapts to the card, chosen operation way according to the position of tumour to the gastric carcinoma case, don't implement the whole gastrectomy [Fig. 6 ] without exception.
And, operation way and operating sequence that the gastrointestinal tract rebuild excise the glandular stomach jejunum anastomosis of colon with the stomach time completely, attentive matters and skill aftertreatment are the same as the whole gastrectomy in the skill.
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