改良空肠间置术在SiewertⅡ型和Ⅲ型食管胃结合部腺癌根治术中的应用  

Application of modified double tracks anastomosis in patients with Siewert adenocarcinoma of the esophagogastric junction treated with radical gastrectomy

作　　者：赵群[1] 李勇[1] 杨沛刚[1] 檀碧波[1] 范立侨[1] 焦志凯[1] 赵雪峰[1] 张志栋[1] 王冬[1] 刘羽[1] 田园[1] 

机构地区：[1]河北医科大学第四医院外三科,石家庄050011

出　　处：《中华胃肠外科杂志》2015年第5期437-441,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：河北省普通高校强势特色学科资助项目[冀教高（2005）52]

摘　　要：目的：探讨改良空肠间置术在SiewertⅡ型和Ⅲ型食管胃结合部腺癌（AEG）根治术中的应用效果。方法回顾性分析河北医科大学第四医院外三科2004年1月至2008年12月期间经开腹行根治术的763例SiewertⅡ型和Ⅲ型AEG患者的临床资料。其中行根治性近侧胃大部切除改良空肠间置术266例（空肠间置组）；根治性近侧胃大部切除食管残胃吻合术252例（食管残胃吻合组）；根治性全胃切除食管空肠Roux-en-Y吻合术245例（Roux-en-Y吻合组）。对3组患者的手术根治性、安全性、生活质量及预后进行比较。结果空肠间置组、食管残胃吻合组和Roux-en-Y吻合组术后并发症发生率分别为8．6％（23／266）、8．3％（21／252）和7．8％（19／245），3组间差异无统计学意义（P＞0．05）。空肠间置组术后6个月胃肠道症状GSRS评分、反流症状Visick分级和反流症状内镜Los Angeles（LA）分级优于食管残胃吻合组（均P＜0．05）；空肠间置组GSRS评分和术后6个月进食量恢复百分比值均优于Roux-en-Y吻合组（均P＜0．05）。术后3年空肠间置组和食管残胃吻合组残胃复发率分别为0．8％（2／244）和1．2％（3／224），差异无统计学意义（P＞0．05）。空肠间置组、食管残胃吻合组和Roux-en-Y吻合组5年总生存率分别为48．7％、46．3％和50．2％，差异无统计学意义（P＞0．05）。结论改良空肠间置术是SiewertⅡ型和Ⅲ型AEG根治术后较为理想的手术方式。Objective To discuss the effect of modified double tracks anastomosis in patients with type Siewert Ⅱ-Ⅲ adenocarcinoma of the esophagogastric junction （AEG） treated with radical gastrectomy. Methods Clinical data of 763 patients with type Siewert Ⅱ-Ⅲ AEG undergoing radical operation in our department from January 2004 to December 2008 were analyzed retrospectively. Patients were randomized into 3 groups according to the different procedures modes： radical proximal gastrectomy with modified double tracks anastomosis （266 cases）, radical proximal gastrectomy with esophageal gastric stump end-to-side anastomosis （252 cases）, and radical total gastrectomy with esophageal jejunum Roux-en-Y anastomosis（245 cases）. There were no significant differences in general information and biological characteristics among the 3 groups （all 〉0.05）. Radical degree, safety, quality of life and prognosis were compared among 3 groups. Results There were no significant differences in postoperative complications among the three groups （〉0.05）. Six months after operation, in modified double tracks anastomosis group, food intake recovery percentage was superior to the other two groups, and the Visick scores and endoscopic grading were better than esophageal gastric stump end-to-side anastomosis group （all P〈0.05）. There was no significant difference in recurrent rate of gastric stump between modified double tracks anastomosis group and esophageal gastric stump end-to-side anastomosis group （〉0.05）. The 5-year overall survival rate of these 3 groups was 48.7%, 46.3%and 50.2% respectively, and no significant difference was found （all 〉0.05）. Conclusion Modified double tracks anastomosis is an ideal surgical method for type Ⅱ-Ⅲ AEG.

关 键 词：食管胃结合部腺癌 改良空肠间置术 食管反流 生活质量 

分 类 号：R735[医药卫生—肿瘤]