胃癌的外科治疗课件

胃癌的外科治疗流行病学资料发病率：消化道肿瘤首位死亡率：25.21/10万病因：高危因素年龄胃溃疡、息肉、萎缩性胃炎、残胃胃粘膜上皮异性性增生HP感染环境和饮食EpidemiologyEGC（1962）MSMTOTAL：10%~20%Japan：30%~40%China：increasinglyimproved进展期胃癌：中、晚期胃癌Borrmann分型：非浸润型（Ⅰ、Ⅱ）浸润型（Ⅲ、Ⅳ）部位胃窦：50%贲门胃体浸润和转移直接浸润淋巴结转移血行转移腹膜转移StagingClassification(UICC)TclassificationT1(tumorinvasionofmucosaandsubmucosa)T2(tumorinvasionofmuscularispropriaorsubserosa)T3(tumorinvasionofserosa)T4(tumorinvasionofadjacentstructures)NclassificationaccordingtoTNM—1987N0(noregionalnodesmetastasis)N1(metastasisinperigastricnodeswithin3cmoftheedgeoftheprimarytumor)N2(metastasisinperigastricnodes.3cmfromtheedgeoftheprimarytumororintheotherregionalnodes)M1a(metastasisin13、14、16regionalnodes)NclassificationaccordingtoTNM—1997N0(noregionalnodesmetastasis)N1(metastasisin1–6regionalnodes)N2(metastasisin7–15regionalnodes)N3(metastasisin.15regionalnodes)M1a(metastasisin13、14、16regionalnodes)N1<3cmN2>3cm（N7，8，9，11）N12,13,14,16—M1StageClassification(UICC)N0——noneN1——1-6N2——7-15N3——〉1519871997StageClassification(UICC，1987)N0N1N2N3T1IAIBIIIVT2IBIIIIIAT3IIIIIAIIIBT4IIIAIIIBM112、13、14、16——IV临床表现早期胃癌无明显症状！Clinicalfeatures

症状百分比（%）

无症状47.6轻度消化不良31.2似溃疡样症状17.9其他3.3诊断X线钡餐检查胃镜超声：BUS、EUSCT治疗原则手术为主的综合治疗SurgicaltreatmentApproachesIntraluminal

endoscopyLaparoscopyLaparotomyThoraco-laparolomyOthersOperativeproceduresMucosectomyWedgeresectionSegmentalresectionProximalgastrectomyPyloruspreservinggastrectomyDistalgastrectomyTotalgastrectomyOtherresectionBypasswithoutresectionExplorat