SiewertⅡ型和Ⅲ型食管胃结合部腺癌近端胃切除术间置空肠单通道和双通道消化道重建的前瞻性随机对照研究  

Jejunal interposed single-tract and double-tract reconstruction after proximal gastreetomy for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction： a prospective randomized controlled study

作　　者：陶凯[1] 黄庆兴[1] 张万红[1] 韩俊亮 马俊[1] 董剑宏[1] Tao Kai;Huang Qingxing;Zhang Wanhong;Han Junliang;Ma Jun;Dong Jianhong(Department of Digestive Minimally Invasive Surgery,Affiliated Tumor Hospital of Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院山西医科大学附属肿瘤医院山西省第三人民医院消化外科微创中心,太原030013

出　　处：《中华消化外科杂志》2018年第8期830-835,共6页Chinese Journal of Digestive Surgery

基　　金：山西省科技厅科技攻关项目（20150313007-7）

摘　　要：目的：探讨Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌（AEG）近端胃切除术间置空肠单通道和双通道消化道重建的临床疗效。方法：采用前瞻性研究方法。选取2013年8月至2016年11月山西省肿瘤医院收治的108例Siewert Ⅱ型和Ⅲ型AEG患者的临床病理资料。采用随机数字表法将患者随机分为 2组，患者均行近端胃切除术，术中消化道重建采用间置空肠单通道法设为单通道组；术中消化道重建采用间置空肠双通道法设为双通道组。单通道组患者消化道重建方法：远端空肠与食管行端侧吻合，残胃后壁与空肠侧侧吻合后，在吻合口以下3 cm处结扎空肠形成单通道，近端空肠与距单通道结扎线20 cm处空肠行侧侧吻合。双通道组患者：消化道重建同单通道组患者，但术中不结扎空肠。术后病理学检查结果显示为淋巴结阳性或肿瘤浸透胃壁全层的患者行化疗。观察指标：（1）术中及术后情况。（2）随访情况。由课题组随访人员及我院第三方随访室，采用电话方式进行随访，了解患者并发症、术后胃肠消化功能及体质量情况。随访时间截至2017年11月。正态分布的计量资料以±s表示，组间比较采用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。重复测量的数据采用重复测量方差分析。计数资料比较采用x2检验。等级资料采用Kruskal Wallis H检验。结果：筛选出符合研究条件的患者108例，单通道组55例，双通道组53例。（1）术中及术后情况：单通道组患者总手术时间、消化道重建时间、术中出血量、术后肛门首次排气时间、术后并发症（胃食管反流和肠梗阻）、Visick分级〉Ⅱ级、术后住院时间分别为（145±26）min，（30±6）min，（181±37）mL，（53±16）h，1、1例，1例，（10.0±2.4）d；双通道组分别为（139±29）min，（26±3）min，（176±31）mL，（5Objective：To investigate the clinical efficacy of jejunal interposed singletract and doubletract reconstruction after proximal gastrectomy for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction （AEG）. Methods：The prospective study was conducted. The clinicopathological data of 108 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to the Affiliated Tumor Hospital of Shanxi Medical University between August 2013 and November 2016 were collected. All the patients underwent proximal gastrectomy and were allocated into the 2 groups by random number table, including patients using singletract jejunal interposition reconstruction in the singletract group and patients using doubletract jejunal interposition reconstruction in the doubletract group. Digestive tract reconstruction： after end-to-side anastomosis between distal jejunum and esophagus and side-to-side anastomosis between posterior wall of the gastric remnant and jejunum, singletract jejunal reconstruction was done through ligating jejunum at 3 cm below the anastomotic stoma, and then side-to-side anastomosis between proximal jejunum and jejunum was performed in the singletract group. Patients in the doubletract group used the same digestive tract reconstruction, but jejunum was not ligated. The postoperative pathological examinations showed that patients with positive lymph nodes or tumor invading all layers of gastric wall underwent chemotherapy. Observation indicators： （1） intra and postoperative situations; （2） followup situations. Followup using telephone interview was performed to detect postoperative complication, gastrointestinal function and body mass index （BMI） up to November 2017. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using t test. Measurement data with skewed distribution were described as M （range）, and comparison between groups was analyzed using the nonparametric test. Repeated measurement data were analyzed by the re

关 键 词：食管胃结合部肿瘤 腺癌 近端胃切除术 Siewert Ⅱ型 Siewert Ⅲ型 消化道重建 单通道 双通道 

分 类 号：R735[医药卫生—肿瘤]