SiewertⅡ型和Ⅲ型食管胃结合部腺癌全胃与近端胃切除术的疗效比较  

Comparison of the efficacies of total gastrectomy and proximal gastrectomy for the treatment of Siewerttype H and HI adenocarcinoma of the esophagogastric junction

作　　者：黄雷[1] 徐阿曼[1] 韩文秀[1] 李团结[1] 韦之见[1] 吴珊珊[1] 王洋溢 

机构地区：[1]合肥,安徽医科大学第一附属医院普通外科,230032

出　　处：《中华消化外科杂志》2014年第2期110-114,共5页Chinese Journal of Digestive Surgery

基　　金：安徽省2012年度第三批科技计划（12070403061）

摘　　要：目的探讨SiewertⅡ、HI型食管胃结合部腺癌（AEG）全胃与近端胃切除术的临床疗效。方法回顾性分析2012年6月至10月安徽医科大学第一附属医院收治的63例SiewertⅡ、llI型AEG患者的临床资料。其中33例患者采用全胃切除术（全胃切除术组），30例患者采用近端胃切除术（近端胃切除术组），分析比较两组患者的根治效果、术后胃肠功能恢复与胃食管反流情况及肿瘤复发情况、生命质量等指标。计数资料采用矿检验，计量资料采用t检验。结果全胃切除术组患者R。切除32例、R，切除1例，近端胃切除术组患者R。切除22例、R，切除8例，两组比较，差异有统计学意义（，=5．369，P〈0．05）。全胃切除术组患者A级根治28例、B级根治3例、c级根治2例，近端胃切除术组患者A级根治15例、B级根治5例、c级根治10例，两组比较，差异有统计学意义（，=10．177，P〈0．05）。全胃切除术组和近端胃切除术组近端切缘长度分别为（4．1±1．4）em和（3．9±1．6）em，两组比较，差异无统计学意义（t=0．666，P〉0．05）；而远端切缘长度分别为（8．1±2．6）cm和（4．2±2．6）em；淋巴结清扫数目分别为（25±4）枚和（21±4）枚；阳性淋巴结检出数目分别为（11±3）枚和（8±4）枚，两组比较，差异均有统计学意义（t=6．043，4．300，3．274，P〈0．05）。全胃切除术组和近端胃切除术组术后肠鸣音恢复时间分别为（1．3±0．5）d和（1．6±0．5）d；肛门排气时间分别为（3．1±0．7）d和（3．5±0．7）d；进食时间分别为（4．7±1．0）d和（5．3±1．2）d；术后住院时间分别为（10．0±2．0）d和（12．0±2．0）d，两组比较，差异均有统计学意义（t=-2．443，-2．059，-2．078，-4．037，P〈0．05）。全胃切除术组和近端胃切除术组术后第6天胃液TBil分别为（13±10）txmol／L和（414-18）Ixmol／L；IBiObjective To compare the clinical efficacies of total gastrectomy （TG） and proximal gastrectomy （PG） in treating Siewert type H and HI adenocarcinoma of the esophagogastric junction （AEG）. Methods The clinical data of 63 patients with Siewert type ]] and m AEG who were admitted to the First Affiliated Hospital of Anhui Medical University from June 2012 to October 2012 were retrospectively analyzed. All the patients were divided into the TG group （ 33 cases） and the PG group （30 cases）. The efficacy of radical resection, recovery of gastrointestinal function, postoperative esophageal reflux, postoperative tumor recurrence and postoperative quality of life of the 2 groups were compared. The count data and the measurement data were analyzed using the chi- square test and the t test, respectively. Results The numbers of patients who received R0 and R~ resection in the TG group were 32 and 1, which were significantly different from 22 and 8 in the PG group （X2 = 5. 369, P 〈 0.05）.The numbers of patients who received grade A, B, C TG were 28, 3 and 2, which were significantly different from 15, 5 and 10 in the PG group （X2= 10. 177, P〈0.05）. The lengths of proximal resection margins were （4.1 _＋ 1.4 ） cm in the TG group and （3.9 -＋ 1.6） cm in the PG group, with no significant difference between the 2 groups （ t = 0. 666, P 〉 0.05 ）. The length of distal resection margin, number of lymph nodes resected, lymph nodes with positive expression were （8.1 _2.6）era, 25 ___4, 11 _＋3 in the TG group, and （4.2 _＋2.6）era, 21 _＋4 and 8 _＋4 in the PG group, with significant differences between the 2 groups （t = 6. 043, 4. 300, 3. 274, P 〈 0.05）. The time for bowel sound restoration, time to first flatus, time to diet and duration of postoperative hospital stay were （1.3_＋0.5）days, （3.1 _＋0.7）days, （4.7_＋1.0）days and （lO. 0 -＋ 2. 0 ） days in the TG group, and （1.6_＋ 0.5 ） days, （ 3.5 _＋ 0.7 ） days, （5.3 _＋ 1.2 ） days and

关 键 词：食管胃结合部腺癌 胃切除术 安全性 疗效 

分 类 号：R735.2[医药卫生—肿瘤]