根治性胃切除术治疗SiewertⅡ和Ⅲ型食管胃结合部腺癌的疗效分析  

Analysis of the therapeutic efficacy of radical gastrectomy in Siewert type H and !II adenocarcinoma of the esophagogastric junction

作　　者：郑国良[1] 郑志超[1] 赵岩[1] 张涛[1] 张剑军[1] 

机构地区：[1]辽宁省肿瘤医院中国医科大学临床肿瘤学院胃外科,沈阳110042

出　　处：《中华肿瘤杂志》2016年第7期538-542,共5页Chinese Journal of Oncology

基　　金：辽宁省科技厅科学技术计划（2012225016）

摘　　要：目的 探讨根治性胃切除术治疗SiewertⅡ和Ⅲ型食管胃结合部腺癌（AEG）的术后并发症和疗效。方法 回顾性分析2006年1月至2008年12月间行根治性胃切除术的163例SiewertⅡ和Ⅲ型AEG患者的临床资料，其中根治性全胃切除术组（TG组）85例，根治性近端胃切除术组（PG组）78例。分析两组患者的3、5年生存率以及术后并发症和病死率。结果 TG组患者的3、5年生存率分别为71.4%和47.6%，高于PG组的56.6%和34.7%，差异有统计学意义（P〈0.05）。TG组患者术后并发症的发生率和病死率分别为12.9%和4.7%，PG组分别为19.2%和2.6%，差异无统计学意义（P〉0.05）。TG组患者发生术后反流性食管炎1例，发生率为1.2%；PG组术后反流性食管炎6例，发生率为7.7%，差异有统计学意义（P〈0.05）。结论 如果SiewertⅡ和Ⅲ型AEG患者的肿瘤直径〉3 cm、浸润达浆膜下层或浆膜层、淋巴结转移为N3期、TNM分期为Ⅲ期，应考虑行根治性全胃切除术，以提高疗效。全胃切除术不会增加患者的术后并发症发生率和病死率，且能有效地防止术后反流性食管炎的发生。Objective To conduct a retrospective analysis of clinicopathological data of patients with Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction （AEG） , who underwent total gastrectomy （TG） or proximal gastrectomy （PG）, to discuss the differences between the two groups in 3- year and 5-year survival rates, postoperative complications and so forth, and to provide theoretical and clinical basis for choosing an ideal surgical approach for patients with Siewert type Ⅱ and Ⅲ AEG. Methods The clinical data of 163 patients who underwent radical gastreetomy from January 2006 to December 2008 were analyzed retrospectively. Among them, 85 patients received total gastrectomy （ group TG） and 78 patients received proximal gastrectomy （group PG）. The 3-year and 5-year survival rates, and postoperative complication rate and mortality rate in the two groups were followed up and compared. Results The 3-year and 5-year survival rates of the group TG were 71.4% and 47.6-/0, and those of the group PG were 56.6% and 34.7%, showing a statistically significant difference （χ^2 = 4.67, P = 0.031 ; χ^2 = 5.17, P = 0.023 ）. The postoperative complication rate and mortality rate of the group TG were 12.9% and 4.7% and those of the group PG were 19.2% and 2.6%, with a nonsignificant difference between the two groups （P〉0.05）. The incidence of reflux esophagitis in the group TG was 1.2%, significantly lower than that of 7.7% in the group PG （P〈0.05）. Conclusions To improve the long-term therapeutic effects, total gastrectomy should be recommended for patients with Siewert type Ⅱ and Ⅲ AEG having high risk factors such as tumor size 〉3.0 cm, subserosal or serosal invasion, N3 lymph node metastasis and stage m tumor. The postoperative complication rate and mortality rate should not be increased, and reflux esophagitis can be effectively avoided in the patients treated with total gastrectomy.

关 键 词：食管胃接合处肿瘤 腺癌 胃切除术 预后 

分 类 号：R735[医药卫生—肿瘤]