近端胃癌根治术不同消化道重建方式近期疗效及生活质量的比较  

Comparison of short-term efficacy and quality of life of different digestive tract reconstruction methods in radical resection of proximal gastric cancer

作　　者：于震 王海江[1] YU Zhen;WANG Haijiang(Affiliated tumor hospital,Xinjiang Medical University,Urumqi,830011,China)

机构地区：[1]新疆医科大学第三附属肿瘤医院,乌鲁木齐830011

出　　处：《新疆医学》2024年第8期947-953,共7页Xinjiang Medical Journal

摘　　要：目的比较近端胃癌根治术不同消化道重建方式的近期临床疗效及术后生活质量。方法回顾性分析新疆医科大学附属肿瘤医院自2019年1月至2021年12月3月间行根治性手术治疗的胃上部癌以及食管胃结合部癌胃癌患者160例,其中行全胃切除术Roux-en-Y式吻合80例,行近端胃切除管状残胃食管吻合34例,间置空肠吻合18例,双通道吻合28例。比较接受全胃切除或近端胃切除的两组患者的基本资料、手术相关指标、术后恢复指标及相关并发症,通过Visick分级、EORTCQLQ-C30量表联合评估术后1年各组患者的生活质量。结果与近端胃切除术相比,食管空肠吻合方式病人手术时间更短,差异有统计学意义(P<0.05)。不同近端胃消化道重建方式与食管空肠吻合方式相比,在术中失血量、淋巴结清扫数目等手术质量控制方面无差异,(P<0.05)。食管空肠吻合组及管状胃组相较于间置空肠及双通道吻合方式术后进食流质饮食开始时间早、术后住院时间短,差异有统计学意义(P<0.01)。各组病人的早期并发症发生率差异均无统计学意义(P>0.05)。双通道吻合及间置空肠吻合方式早期可显示出抗反流优势,但胃食管反流症状在管状胃吻合组远期随访中显示出更好的改善趋势。术后1年EORTC QLQ-C30问卷调查显示与食管空肠吻合相比,双通道组及间置空肠组患者在总健康状况、身体功能、角色功能、情绪功能、认知功能等方面较优(P<0.05)。结论间置空肠吻合、管状胃吻合及双通道吻合,三种消化道重建方式在近端胃癌治疗中较全胃切除食管空肠吻合均可行,都显示出良好的近期疗效,同时改善患者术后反流症状,提升生活质量。Objective To compare the short-term clinical effects and postoperative life of different digestive tract reconstruction after radical gastrectomy for proximal gastric cancer.Methods From January 2019 to December 2021,160 patients with upper gastric cancer and esophagogastric junction cancer were treated by radical surgery in tumor hospital affiliated to Xinjiang Medical University.Among them,80 patients underwent total gastrectomy,Roux-en-Y anastomosis,80 patients underwent proximal gastrectomy.Among them,34 patients underwent gastric tube esophagogastrostomy(GT),18 patients underwent jejunal interposition(JI)and 28 patients underwent double-tract reconstruction(DTR).Basic data,surgery-related indexes,postoperative recovery indexes and related complications were compared between the two groups of patients who underwent total gastrectomy or proximal gastrectomy.The quality of life of each group 1 year after surgery was assessed by Visick scale and EORTCQLQ-C30.Results Compared with proximal gastrectomy,the operation time of esophagojejunostomy patients was shorter(P<0.05).Compared with esophagojejunostomy,different proximal gastrointestinal reconstruction had no difference in surgical control such as blood loss and sweeping number(P<0.05).Compared with JI group and DTR group,the time of starting liquid diet was earlier and the time of hospitalization was shorter in the esophagojejunostomy group and GT group(P<0.01).There was no significant difference in the incidence of early complications among the groups(P>0.05).JI group and DTR group showed the advantage of anti-reflux in the early stage,but with the prolongation of postoperative recovery time,the patients adapted to the postoperative diet and habit of gastroesophageal reflux symptoms in GT group showed a better improvement trend.The results of EORTC QLQ-C30 questionnaire 1 year after operation showed that the patients in the DTR group and the JI group were better than those in the total health status,physical function,role function,emotional function and cogni

关 键 词：近端胃恶性肿瘤 消化道重建方式 生活质量评估 

分 类 号：R735.2[医药卫生—肿瘤]