Study Between Spleen Preservation And Splenectomy Of Advanced Gastric Cancer On Indications

The surgical treatment of advanced gastric cancer is the standard radical correction and enlarged radical correction. Rear lymphatic of gastric cardia cancer drainage into the the lymph nodes at the splenic hilum and along the splenic artery, so total gastrectomy is required for dissection of the lymph nodes at the No.10 and No.11 Group. For the past sweeping No.10 and No.11 Group Group lymph nodes, often at the same time line pancreatic tail, the spleen removed. In recent years on the stomach, the central cancer, sweeping No.10 and No.11 Group Group lymph nodes to the left side of the semi-pancreatectomy, has made similar recognition that preventive sweeping No.10 and No.11 Group Group lymph nodes, do not have to To the left half pancreatic resection. However, advanced gastric cancer cure, is the spleen removed still more controversial. This paper aims to explore advanced gastric cancer of the spleen surgery reasonable surgical indications. Gastrointestinal surgery in our hospital since March 2005 to February 2008 total gastrectomy for stomach cancer surgery in patients treated with 50 cases, in accordance with the Joint splenectomy, is divided into security spleen (TG) group and the splenectomy (TGS) Group . TGS Group 18 cases, of which 13 cases of males and 5 females, age 33, -78, the average age of 53.6±3.4 years. TG group of 32 cases, of which 25 cases of men and 7 women, age 21 years -75 years old, the average age of 51.4±3.1 years. The two groups X2 test no significant difference (P> 0.05). Preoperative gastroscopy TG group in the U District 10 cases of gastric cancer, M District 14 cases of gastric cancer, L zone eight cases of gastric cancer; TGS Group in the U District 6 cases of gastric cancer, M district eight cases of gastric cancer, L zone four cases of gastric cancer, there was no Significant difference. TMN pathological stage after the TG groupⅠB Phase two cases,Ⅱperiod of five cases,ⅢA period of five cases,ⅢB of 10 cases,Ⅳperiod of 10 cases; TGS GroupⅠB Phase 1 cases,Ⅱperiod of 11 cases,ⅢA period 1 cases,ⅢB Phase two cases,Ⅳperiod of three cases. Two cases were used on the longitudinal center of abdominal incision and around Qixia 5 cm. After the conventional open-wide exploration of abdominal tumor after determining the size of the stomach week metastasis be assessed. TG group Oxfam in accordance with the following order: omentum and transverse colon of the film before stripping of the block up, on the margin of direct access to the pancreas, spleen Qu left of the colon, liver Qu right of the colon. Duodenal ligament in the duodenum and liver, liver sweeping duodenal ligament in lymph nodes (No.12). Since the roots cut off the right gastroepiploic artery, cleaning stomach big bend, the lymph nodes under the pylorus (No.4, No.6), since the liver margin cut off small omentum, cut off the right gastric artery, and lymph node dissection of Helicobacter pylori (No .5). Duodenal transection of the ball, double-stump sutured. Since the roots cut off the left gastric artery, sweeping left gastric artery next to next to hepatic artery, abdominal artery adjacent lymph nodes (No.7, No.8, No.9). Since the splenic artery isolated from spleen door, cut off the roots of the gastroepiploic left, stomach and the stomach after a short vessel, while sweeping the door spleen artery lymph nodes and spleen (No.10, No.11). Separation of esophageal blunt fingers around the vagus nerve ligation cut off before and after the dry cleaning cardiac right and left cardiac lymph nodes (No.1, No.2). Cardia, in the final 3-4 cm off after the esophagus esophageal jejunum Rouxen-Y anastomosis. In addition, additional splenectomy, TGS Group operation methods in line with the TG group, in addition TGS group were placed in the spleen bed drainage hose.This set of data in the TGS Group in the operation time and the number of hospitalization days than the TG group was extended by two groups of two X2 test (P <0.01) were significantly different, statistically significant. Tip total gastrectomy for gastric cancer Joint splenectomy on the survival of patients with a negative impact. This set of data in the TGS Group and TG group incision infection rate (TGS Group 22.22%, TG Group 18.75%), lung infection (TGS Group 6.22%, TG group 3.13 percent), the infection rate below the diaphragm (TGS Group 27.78 %, TG group 6.25 percent) and the incidence of pancreatic fistula (TGS Group 27.78%, TG group 9.37 percent) X2 test only the infection rate below the diaphragm and the incidence of pancreatic fistula significant difference (P <0.05), and we pass this Strictly sterilized during operation, the need to protect the incision, postoperative wound dressing change in time, a decrease of wound infection suppurative opportunities, and encourage patients through after early get out of bed, early removal of nasogastric tube, early resumption of oral consumption and reduce the Postoperative fever, atelectasis, and the incidence of pneumonia, after two groups of wound infection and lung infection rate was not significantly different. TGS Group subphrenic infection rate was higher than the TG of TGS we consider the group a higher incidence of pancreatic fistula caused by splenectomy and no obvious correlation. This set of data No10, No11 Group metastasis rate TGS group were 15.62%, 18.75%, TG group were 22.22%, 22.22%. Basically, with the reported agreement, we believe that No10, No11 Group lymph nodes have a higher transfer rate. Two groups of patients with No10, No11 Group metastasis rate no significant difference (P> 0.05), prompted largely retained spleen surgery to remove the spleen with pancreatic lymph nodes of 10, 11 Group purposes. The research group in the TGS group stageⅣthree cases, two cases ofⅢB period in both see cancer has invaded through serous layer, spleen and close the door adhesion lymph nodes or spleen door into Mission fixed transfer, wrapping spleen doors, with only Spleen to achieve the objective of radical tumor. Confirmed after pathological lymph node cancer spleen door for the transfer of positive results. Our view: consider splenectomy greater trauma and loss of the spleen and reduce the body's immune capability, splenectomy on survival in patients with a negative impact on the progress of gastric cancer suspected No.10, No.11 Group metastasis are encouraged Avoid making preventive splenectomy, and basically retain the spleen surgery to remove the spleen with pancreatic lymph nodes of 10, 11 Group purposes. Joint splenectomy gastric cancer tumors should be limited to a direct violation of the spleen, pancreas and spleen cancer or close the door adhesion, spleen doors Mission fixed transfer into lymph nodes, spleen wrapping the door. The following conclusions can be drawn: 1, splenectomy or postoperative infection and complications unrelated. 2, advanced gastric cancer on suspected No.10, No.11 lymph node metastasis group should be avoided for preventive splenectomy. 3, spleen preservation in total gastrectomy can remove suspicious No.10, No.11 group lymph nodes. 4, splenectomy shoule be limited in those patients with gastric cardia tumors invading spleen or with metastatic bulky lymph nodes extending to the spleen.