全胃切除与近端胃大部切除对SiewertⅡ型食管胃结合部腺癌患者近期预后影响的对照研究  

Comparison effect of short-term prognosis of total gastrectomy and proximal subtotal gastrectomy for Siewert Ⅱesophagogastric junction adenocarcinomas

作　　者：尉鹏 夏清华 唐学虎 朱黎明 WEI Peng;XIA Qinghua;TANG Xuehu;ZHU Liming(Department of General Surgery,the First Hospital of Danjiangkou,Danjiangkou 442700;Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,China)

机构地区：[1]湖北省丹江口市第一人民医院普外科,湖北丹江口442700 [2]华中科技大学同济医学院附属协和医院

出　　处：《胃肠病学和肝病学杂志》2018年第6期657-660,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨全胃切除术与近端胃大部切除术对SiewertⅡ型食管胃结合部(esophagogastric junction,EGJ)腺癌患者的近期预后。方法收集2012年1月至2015年1月湖北省丹江口市第一人民医院收治的67例EGJ腺癌患者,根据不同术式分为两组:对照组31例,行近端胃大部切除术治疗,观察组36例,行全胃切除术治疗。比较两组患者的手术情况及术后情况;随访24个月,比较两组患者的生存率。结果观察组手术时间、淋巴结清扫数目、阳性淋巴结检出数目、远端切缘长度明显高于对照组,R1切除率明显低于对照组(P均<0.05);观察组进食时间、排气时间、肠鸣音恢复时间及住院时间均明显低于对照组(P均<0.05);两组患者术后并发症发生率比较,差异无统计学意义(P>0.05);术后12个月,观察组胃食管反流病问卷(GERD-Q)评分明显低于对照组(P<0.05);随访24个月,两组患者生存率比较,差异无统计学意义(P>0.05)。结论全胃切除术治疗SiewertⅡ型EGJ腺癌的生存率与近端胃大部切除术相近,但全胃切除术提高了淋巴结清扫效果,促进了患者术后早期恢复,减轻了胃食管反流症状,值得临床重视。Objective To investigate the effect of short-term prognosis of total gastrectomy and proximal subtotal gastrectomy for Siewert Ⅱ esophagogastric junction（ EGJ） adenocarcinomas. Methods Sixty-seven patients with EGJ adenocarcinomas were collected from Jan. 2012 to Jan. 2015,according to the different surgical methods,patients were divided into two groups： 31 cases in the control group underwent proximal subtotal gastrectomy,36 cases in the observation group underwent total gastrectomy. The operation and postoperative situation were compared between two groups. After 24 months of follow-up,the survival rates were compared between two groups. Results The operation time,the number of lymph node dissection,positive lymph node number,distal margin length in observation group were significantly higher than those in the control group,the R1 resection rate was significantly lower in observation group than that in the control group（ P 0. 05）. Feeding time,exhaust time,borborygmus recovery time and hospitalization time in the observation group were significantly lower than those in the control group（ P 0. 05）; there was no significant difference in the incidence of postoperative complications between two groups（ P 0. 05）; 12 months after the operation,the GERD-Q score in the observation group was significantly lower than that in the control group（ P 0. 05）;after 24 months of follow-up, survival rate had no significant difference between two groups（ P 0. 05）.Conclusion The survival rate of total gastrectomy for the treatment of Siewert Ⅱ EGJ adenocarcinomas is similar to that of the proximal subtotal gastrectomy,but total gastrectomy can improve the effect of lymph node dissection,promote the early recovery of patients,and alleviate gastroesophageal reflux symptoms,it is worthy of clinical attention.

关 键 词：食管胃结合部腺癌 全胃切除术 近端胃大部切除术 疗效 近期预后 

分 类 号：R735.2[医药卫生—肿瘤]