手术治疗胃底部肿瘤3种消化道重建方式疗效对比分析  

Comparctive study on different reconstruction procedures after gastrectomy of proximal gastric carcinoma

作　　者：李建昌[1] 陈仕才[1] 杨国华[1] 刘海鹰[1] 

机构地区：[1]广州医科大学附属肿瘤医院胃肠肿瘤外科,广东广州510095

出　　处：《中国实用外科杂志》2014年第11期1086-1089,共4页Chinese Journal of Practical Surgery

基　　金：广东省教育厅基金项目(No.2013LYM0069);广州医科大学博士启动基金(No.2011C57)

摘　　要：目的探讨不同消化道重建方式应用于近端胃切除术后的疗效。方法回顾性分析2003年1月至2012年1月广州医科大学附属肿瘤医院行手术治疗的75例胃底部肿瘤病人的临床资料,26例行近端胃切除术+食管胃吻合术(EG组),27例行全胃切除+食管空肠Roux-en-Y吻合术(RY组),22例接受近端胃切除术后行食管胃吻合+胃空肠吻合术(EGJ组)。比较3组病人的手术时间、术中出血量、术后并发症及营养指标等。结果 3组病人的手术时间、术中出血量及术后12个月的各营养指标的差异均无统计学意义(P>0.05)。EG组病人反流性食管炎发生率(57.7%)明显高于RY组(11.1%)和EGJ组(9.0%)(P<0.05);EGJ组病人无重度反流性食管炎发生。结论食管胃吻合+胃空肠吻合术可有效降低近端胃切除术后反流性食管炎的发生率,是一种简单且有效的重建方式。Objective To explore the efficacy of esophagogastrostomy plus gastrojejunostomy reconstruction after proximal gastrectomy. Methods The clinical data of 75 cases of gastrectomy for proximal gastric neoplasm between January 2003 and January 2012 at the Affiliated Tumor Hospital of Guangzhou Medical University were analyzed retrospectively. There were 26 cases of proximal gastrectomy followed by esophagogastrostomy reconstruction （EG）, 27 cases of total gastrectomy and Roux-en-Y reconstruction （RY） and 22 eases of proximal gastrectomy followed by esophagogastrostomy plus gastrojejunostomy reconstruction （EGJ） respectively. The clinicopathological features, operation time, intraoperative bleeding volume, postoperative complications and nutritional status were compared among three different reconstruction types. Results The operation time, intraoperative bleeding volume and nutritional status in postoperative 12 months were similar among the three groups （P 〉 0.05）. The incidence of reflux esophagitis in the EG group （57.7%） was higher than that in the RY （11.1%） and EGJ groups （9.0%） significantly （P〈0.01）. No case in EGJ group suffered from severe reflux esophagitis. Conclusion EGJ procedure can significantly relieve the syndrome of reflux esophagitis and may be a simple and effective reconstruction method after proximal gastrectomy.

关 键 词：胃肿瘤 胃切除术 食管胃吻合术 胃空肠吻合术 

分 类 号：R6[医药卫生—外科学]