For the main method that treats at present, also be the method that may cure progress period cancer of the stomach exclusively. Because this is right,the operation cure of cancer of the stomach should take positive attitude, laparotomy all should apply when wanting allow of circumstance of patient whole body to be able to not have clear far to transfer only.

(One) the choice of all sorts of operations

1, effect a radical cure sexual resection

Also call cure sexual excision. Be about to the kitchen of the primary affection of cancer of the stomach, organization of along with part and its corresponding area lymph node are excised along with all the others, clinical go up not to remain any cancerous organizations. The range that keeps clear of because of its area lymph node again is distinct, and cent effects a radical cure for 4 different kinds art: Did not call what lymph node of the first station keeps clear of completely R. Art form: Keep clear of lymph node of the first station completely form of the art that it is R1, likewise cleared and all the 2nd station or the 3rd station is lymphatic, call R2

Or R3 art form, can transfer degree and lymph node according to lymph node again the relation of cleared limits, divisional to effect a radical cure absolutely with effect a radical cure relatively 2 kinds, effecting a radical cure absolutely is to show lymph node is cleared surmount move lymph node above of the first station, if lymph node of the first station has move, applying R2 or R3 effect a radical cure, call to effect a radical cure absolutely namely. If make R1 operation only, although clinical go up to also transfer lymph node without remaining, but can consider as only effect a radical cure relatively.

The limits that effects a radical cure sexual stomach greater part is excised commonly, should include kitchen range of the primary affection inside stomach of retinal, liver and gastric colon ligament reach the 2/3 ～ 3/4 of gastric near side or far side, total volume the leaf before colon fastens film, duodenum the area lymph node of the first part and stomach. Sometimes gastric body cancer for cleared cardia by, all round lienal door, lienal artery lymph node, the amplification that needs a complete stomach and pancreas body, end and milt to be excised along with all the others effects a radical cure art. When the adjacent viscera such as transverse colon of cancerous swollen drag in or hepatic Zun Xie, also can make along with of viscera of this be put into trouble effect a radical cure the gender combines resection.

Because expand,effect a radical cure the occurence rate of the complication after the operation mortality of art and art is high, answer to master an operation strictly to get used to card so, if do not have the will all cancer of the stomach of the choice to all apply,expand effect a radical cure art, can not raise the survival rate of cancer of the stomach. Think commonly cancer of gastric body ministry, diffuse wellability cancer and the in principle of gastric antrum ministry that already had move of lymph node of the 2nd station should be made expand effect a radical cure art.

About the operation problem of inchoate cancer of the stomach, all advocate R2 art form before. In recent years. As the ceaseless grow in quantity of case of illness of inchoate cancer of the stomach, abound of operation experience increasingly, gathered more clinical data. The inchoate cancer of the stomach that discovers single shot pathological changes its survival rate not only significantly relatively frequently-occurring disease turns into tall, and the recrudescent rate of entire case is inferior also, only 2. 8% , and the recrudescent case of illness of great majority all is the inchoate cancer of the stomach that pathological changes invades companion of mucous membrane lower level to have lymphatic move. The form that additionally its have a relapse also is blood more travel move reachs liver to lung. Another notable is no matter cancer is swollen whether to already invade pathological changes of single shot of mucous membrane lower, 3 kinds of different operation kind -- the survival rate of R0, R1, R2 is not had very difference, think so the operation means of inchoate cancer of the stomach, the cancer inside mucous membrane should make R1 art type, the cancer below mucous membrane makes R2 operation; Be less than the cancer inside 2 centimeters polypous shape mucous membrane, make cancer swollen local excision or R0 art form are completely enough already.

2, appeasement sex excision

To appeasement sex excision also is being put in different opinion. A kind of opinion thinks appeasement sex excision can remove only pylorus block, haemorrhage, aching in order to alleviate symptom, and cannot prolong life. Accordingly, paunch discovers cancer is swollen when cannot effecting a radical cure, abandon excising an operation namely like the person that do not have afore-mentioned complication. Majority thinks, above survives 5 years after the art of patient of cancer of the stomach that appeasement considers as excision when having many operations, even 5 years survival rate can be amounted to 11% the left and right sides. Survival rate of excision of sex of appeasement of domestic statistic cancer of the stomach is amounted to 11. 7% . Appeasement is made excise case of illness in all sorts of different accounts in, the curative effect that carries rudimental cancer in order to cut is optimal, it is next infiltrate all round the stomach, change lymph node and liver move to remain again, and cultivate with peritonaeum for the poorest. Accordingly, swollen to cancer excision should take positive attitude, more not easily will certain can effect a radical cure case of illness makes one simple appeasement excise, make certain patient loses cured chance. So, although already had,exceed effect a radical cure the move that excises limits, want license of circumstance of patient whole body only, when swollen local likelihood excises cancer, still answer to strive for resection of part of appeasement sex stomach actively. As to appeasement complete stomach excision does not advocate commonly, because of mortality and complication occurence rate all taller.

3, short circuit operation if cancer is swollen cannot be excised and pylorus block can make gastric jejunum anastomosis, remove obstruction, make the patient can take food to be accepted in order to improve systemic nutrition state and creation condition other medication.

(2) the preparation before art

Patient of cancer of the stomach is average the condition is poorer, strive for before art in short-term inside offer improvement, with period improve adversary skill be able to bear or endure get power. Patient of terminal cancer of the stomach often has dehydration, anaemic, hidebound. The phenomenon of the retention inside pylorus block and stomach, proper preparation all should undertake before art so, give a few for many times blood transfusion, plasma, in order to correct anaemia and low albumen disease. Cancer of the stomach is intercurrent pylorus block person often have water electrolyte disorder, answer to correct. Before art 3 days begin to use lukewarm brine gastric lavage every night in order to reduce inflammation and mucous membrane oedema, the heal that kisses heal up to bowel of the stomach after art and precautionary cut are affected all helpful. To senile patient, special attention answers to examine case of heart lungs function before art. Bend side cancer greatly in gastric body or stomach swollen, estimation has excision when partial transverse colon is likely, preparation of good bowel path should be made before art.

(responsibility edits: Luo Ying week)