腹腔镜全胃切除术与近侧胃切术治疗胃上部癌的临床效果和预后比较  

Effect of laparoscopic total gastrectomy and proximal gastrectomy on the clinical outcome and prognosis of upper gastric carcinoma

作　　者：龚晓松 王劲 刘细平 

机构地区：[1]湖南省株洲市中心医院普外科,湖南株洲412007

出　　处：《中国现代普通外科进展》2016年第6期443-445,450,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的：比较腹腔镜全胃切除术（全胃Roux-Y切除术）、近侧胃切除术治疗胃上部癌的临床效果及预后影响。方法：回顾性分析我院胃肠外科腹腔镜治疗的137例胃上部癌患者的临床资料及随访资料,其中全胃Roux-Y切除术71例（A组）近侧胃切除术66例（B组）,比较两组手术及预后情况。结果：A组手术时间、术中出血量、术后排气时间、术后进食流质时间均显著长于B组（P〈0.05）,但A组术中清扫淋巴结数目多于B组（P〈0.05）,两组术后卧床时间、住院时间差异无统计学意义（P〉0.05）。A组吻合口狭窄、吻合口瘘、肺部感染、腹腔感染、肠梗阻发生率与B组比较差异无统计学意义（P〉0.05）;术后反流性食管炎发生率显著低于B组,差异具有统计学意义（P〈0.05）。A组3年生存率显著高于B组（63.38%vs43.94%,χ2=5.205,P=0.023）;A组中位生存时间显著长于B组（32个月vs29个月,χ2=5.802,P=0.016）。结论：腹腔镜全胃Roux-Y切除术治疗胃上部癌疗效更佳,患者生存时间更长。Objective： Comparison of iaparoscopic total gastrectomy （a full stomach Roux-Y resection）, proximal gastrectomy of gastric cancer clinical efficacy and prognosis. Methods： A ret rospective analysis of the clinical data and follow-up data of our hospital department of gastrointestinal surgery, the laparoscopic treatment of 137 cases of upper gastric cancer patients, which fullstomach Roux-Y resection 71 cases（group A）, nearly gastrectomy in 66 cases（group B）, compared two groups of surgery and prognosis. Results： A group of operation time, intraoperative bleeding volume, postoperative exhaust time, postoperative eating liquid time were significantly longer than those of group B （P〈 0.05）, but patients in group a underwent dissection lymph node number more than those in group B （P 〈 0.05）, two groups of postoperative bed time, hospitalization time differences had no statistical significance（P〉 0.05）. A group of anastomotic stenosis, anastomotic fistula and pulmonary infection, abdominal cavity infection, intestinal obstruction occurred rate of group A and group B difference no statistical significance （P 〉 0.05）; postoperative reflux esophagitis inci- dence was significantly lower than that in group B, and the difference is statistically significant （P〈 0.05）. The 3 year survival rate of A group was significantly higher than that of B group （63.38% vs 43.94%, χ2=5.205, P=0.023）; The median survival time of A group was significantly longer than that of B group （32 months vs 29 months, χ 2=5.802, P=0.016）. Conclusion： Laparoscopic total gas- trectomy for the treatment of upper gastric cancer is better, and the survival time of patients is longer than that of the patients with Roux-Y.

关 键 词：胃肿瘤 腹腔镜 全胃Roux-Y切除术 近侧胃切除术 预后 

分 类 号：R735.2[医药卫生—肿瘤]