腹腔镜辅助全胃切除术和近端胃切除术治疗食管胃结合部腺癌的疗效分析  

Efficacy analysis of laparoscopy-assisted total gastrectomy and proximal gastrectomy in treatment of adenocarcinoma of esophagogastric junction

作　　者：杨宏[1] 张楠[2] 崔明[1] 邢加迪[1] 吴秀秀[1] 张成海[1] 姚震旦[1] 刘茂兴[1] 苏向前[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心四病区恶性肿瘤发病机制及转化研究教育部重点实验室,100142 [2]泰安市中心医院普通外科,271000

出　　处：《中华消化外科杂志》2016年第11期1062-1067,共6页Chinese Journal of Digestive Surgery

基　　金：国家高技术研究发展计划（863计划）（2014AA020603）;国家自然科学基金（81272766）;首都临床特色应用研究（Z121107001012130）;北京市医院管理局临床医学发展专项（XM201309）

摘　　要：目的：探讨腹腔镜辅助全胃切除术（LATG）和腹腔镜辅助近端胃切除术（LAPG）治疗食管胃结合部腺癌（AEG）的临床疗效。方法：采用回顾性队列研究方法。收集2009年5月至2016年2月北京大学肿瘤医院收治的130例行腹腔镜辅助AEG根治术患者的临床病理资料。130例患者中，91例行LATG，设为LATG 组；39例行LAPG，设为LAPG组。LATG 组和LAPG 组均按照日本《胃癌治疗指南》行D2淋巴结清扫术。腹腔镜下完成淋巴结清扫术后，取腹上区正中小切口辅助行消化道重建：LATG组患者采用食管空肠RouxenY吻合术，LAPG组患者采用食管残胃吻合术。观察指标：（1）术中及术后情况：总体手术情况、中转开腹例数、手术时间、术中出血量、术中输血例数、淋巴结清扫数目、术后肛门排气时间、术后住院时间。（2）术后并发症情况：总体并发症、手术相关并发症（轻微和严重）、再次手术、内科系统并发症、术后30 d内手术相关并发症死亡。手术相关并发症严重程度按照ClavienDindo分级标准进行划分。（3）随访情况。采用门诊、电话或邮件形式进行随访，了解患者生存及肿瘤复发、转移情况。随访时间截至2016年8月31日。总体生存时间指患者自手术当日至末次随访或因该疾病死亡的时间。因2014年9月至2016年2月行手术治疗的48例患者至随访截止时，随访时间〈2年，故仅对2009年5月至2014年8月行手术治疗的82例患者进行生存分析。正态分布的计量资料以±s表示，组间比较采用独立样本t检验，偏态分布的计量资料以M（范围）表示，组间比较采用非参数检验。计数资料比较采用χ^2检验，等级资料比较采用非参数检验。采用KaplanMeier法绘制生存曲线，采用Logrank检验进行生存分析。结果： （1）术中及术后情况：130例AEG患者均顺利完成手术，中转开腹患者7例，中转原因主要为�Objective： To investigate the clinical efficacy of laparoscopyassisted total gastrectomy （LATG） and laparoscopyassisted proximal gastrectomy （LAPG） in treatment of adenocarcinoma of esophagogastric junction （AEG）. Methods：The retrospective cohort study was conducted. The clinicopathological data of 130 patients with AEG who underwent laparoscopyassisted radical gastrectomy at the Peking University Cancer Hospital between May 2009 and February 2016 were collected. Among 130 patients, 91 undergoing LATG were allocated into the LATG group and 39 undergoing LAPG were allocated into the LAPG group. D2 lymph node dissection was applied to patients in the 2 groups according to the Japanese gastric cancer treatment guidelines. Patients received digestive tract reconstruction though a small midline incision in the epigastric region after laparoscopyassisted lymph node dissection： patients in the LATG group and LAPG group received respectively RouxenY esophagojejunostomy and residual stomachesophagus anastomosis. Observation indicators included： （1） intra and postoperative situations： overall surgical situation, number of patients with conversion to open surgery, operation time, volume of intraoperative blood loss, number of patients with intraoperative blood transfusion, number of lymph node dissected, time to anal exsufflation and duration of postoperative hospital stay. （2） Occurrence of complications： overall complications, surgeryrelated complications （slight and severe complications）, reoperation, medical complications and death from surgeryrelated complication within 30 days postoperatively. Severity of complications was evaluated according to ClavienDindo classification. （3） Followup situations. Patients were followed up by outpatient examination, telephone interview and correspondence up to August 31, 2016. Followup included the tumor recurrence and metastasis. Overall survival time was counted from operation date to end of followup or time of death. Because followup time of

关 键 词：食管胃结合部肿瘤 腺癌 胃切除术 腹腔镜检查 安全性 远期疗效 

分 类 号：R735[医药卫生—肿瘤]