胃食管连接部/贲门癌根治术术式选择临床疗效分析  

Analysis of clinical curative effect of surgical options for esophagogastric junction / cardiac cancer

作　　者：卢翔[1] 李向阳[1] 段炜[1] 顾勇[1] 

机构地区：[1]武警陕西总队医院胃肠外科,西安710054

出　　处：《武警医学》2016年第11期1099-1102,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的探讨胃食管连接部/贲门癌根治性切除术及重建术式的临床效果分析。方法分析2004-10至2013-05行胃食管连接部/贲门癌根治切除术患者89例资料,其中26例为近端胃切除术后食管残胃吻合重建(食管胃吻合组),42例为全胃切除术后Roux-en-Y食管空肠吻合重建(食管空肠Roux-en-Y吻合组),21例行近端胃切除术后限制性双通道折叠空肠间置重建(西京术式组),比较3组患者手术指标、术后并发症、营养状态以及术后生存率。结果食管胃吻合组手术时间、出血量均明显少于另两组(均P<0.05);食管空肠Roux-en-Y吻合组淋巴结清扫数明显多于另两组,但营养指标方面不如另两组(均P<0.05);3组并发症总发生率均无统计学差异,但食管空肠Roux-en-Y吻合组倾倒综合征发生率明显高于另两组(均P<0.05);3组患者1、3、5年生存率差异均无统计学意义(χ2=0.440,P=0.803;χ2=0.234,P=0.890;χ2=0.045,P=0.978)。结论三种胃食管连接部/贲门癌手术生存率相似,近端胃切除术加食管残胃吻合创伤性小,近端胃切除术加限制性双通道折叠空肠间置重建术后生活质量更高,临床应根据医师手术技巧和患者实际情况选择方案。Objective To investigate the clinical efficacy and postoperative survival in esophagogastric junction / cardiac cancer patients undergoing different types of radical gastrectomy and reconstruction. Methods clinical records of 89 patients with esophagogastric junction / cardiac cancer undergoing radical gastrectomy between October 2004 and May 2013 were analyzed. Of these patients, 26 cases underwent proximal gastrectomy with esophageal-residual stomach anastomosis （Group A） , 42 underwent total gastrectomy with esophagojejunal Roux-en-Y anastomosis （ Group B）, and 21 underwent proximal gastrectomy with restrictive dual channel between folding jejunum reconstruction （Xijing Operation Group）. Surgery-related parameters, postoperative complications, nutritional status and survival rat were compared between the three groups. Results The operative time and intraoperative blood loss in Group A were significantly decreased compared with the other two groups. The number of lymph nodes dissected was larger but the nutritional indexes were worse in Group B than in the other two groups （ all P 〈0. 05 ）. There was no statistically significant difference in the inci- dence of overall postoperative complications between the three groups, but the incidence of dumping syndrome in Group B was significantly higher than in the other two groups （ all P 〈 0.05 ）. There was no significant difference in 1,3 and 5 year survival rates between the three groups （X2 =0. 440,P =0.803 ;X2 =0. 234,P =0. 890;X2 =0. 045 ,P =0.978）. Conclusions The three surgical procedures can lead to a similar postoperative survival rate for esophagogastric junction / cardiac cancer. Proximal gastrectomy plus esophageal-residual stomach anastomosis is less traumaticwhile proximal gastrectomy with restrictive dual channel between folding jejunum reconstruction allows better quality of life, so the selection of procedures should be based on the surgical skills of physicians and the actual clinical conditions of the patient.

关 键 词：胃肿瘤 胃癌根治术 预后 

分 类 号：R655.4[医药卫生—外科学]