腹腔镜辅助全胃切除术与近端胃切除术治疗SiewertⅡ型食管胃结合部腺癌的近期及远期效果对比研究  

Comparison of short-term and long-term effects of laparoscope assisted total gastrectomy and proximal for Siewert Ⅱ esophagogastric junction adenocarcinoma

作　　者：邹庆涛 张洪贞 尹作文[1] 喻军[1] 张鹏[2] Zou Qinglao;Zhang Hongzhen;Yin Zuowen;Yu Jun;Zhang Peng(Department of Gastro Surgery,Huazhong University of Science and Technology Union Medical College Shenzhen Hospital,Shenzhen Guangdong Province 518000,China;Department of General Surgery,Union Hospital affiliated to Huazhong University of Science and Technology,Wuhan Hubei Province 430022,China)

机构地区：[1]华中科技大学协和深圳医院胃肠外科,深圳518000 [2]华中科技大学同济医学院附属协和医院普通外科,武汉430022

出　　处：《中华普外科手术学杂志（电子版）》2022年第4期395-398,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家自然青年科学基金项目(81702386);广东省自然科学基金项目(2019A030325762)。

摘　　要：目的对比分析腹腔镜辅助全胃切除术(LATG)与近端胃切除术(LAPC)治疗SiewertⅡ型食管胃结合部腺癌(AEG)的近期及远期效果。方法前瞻性纳入2014年1月至2016年5月90例SiewertⅡ型AEG患者的临床资料,采用随机数字表法将患者分为两组:LAPG组和LATG组,每组各45例。LAPG组:行腹腔镜辅助近端胃切除术;LATC组:行腹腔镜辅助全胃切除术。数据应用软件SPSS22.0进行处理。围手术期、营养状况指标等计量资料采用(x±s)表示,独立样本t检验;并发症等计数资料行χ^(2)检验分析;生存分析采用K-M法并行Log-Rank检验。P<0.05表示差异有统计学意义。结果LATC组患者手术时间、淋巴结清扫枚数显著高于LAPC组,首次排气时间、首次进食时间、术后住院时间显著低于LAPG组,差异均有统计学意义(P<0.05);LATG组患者术后反流性食管炎的发生率显著低于LAPG组(6.7%vs.22.2%,P<0.05)。两组患者术后1年血清血红蛋白(Hb)、总蛋白(TP)及白蛋白(ALB)等营养指标比较,差异均无统计学意义(P>0.05)。术后中位随访时间72个月,通过Kaplan-Meier分析显示,LATG组患者术后5年总生存率为51.1%,无病生存率为42.2%;LAPG组患者术后5年总生存率为37.8%,无病生存率为24.4%,两组患者术后5年总生存率及无病生存率比较,差异均有统计学意义(P<0.05)。结论与LAPC相比,LATC治疗SiewertⅡ型AEC不仅有利于患者术后恢复,降低术后反流性食管炎的发生,不增加手术风险及营养不良的发生,且淋巴结清扫更彻底,能达到更好的远期效果。Objective To compare the short-term and long-term effects of laparoscopic-assisted total gstecomy(LATG)and proximal gaslrectomy(LAPG)in the lreatment of Siewert Ⅱ esophagogastrie junction adenoeareinoma(AEC).Methods Clinical data of 90 patients with Siewert Ⅱ AEG from January 2014 to May 2016 were prospectively included.The patients were divided into two groups by random number uable method:LAPG group and LATG group,with 45 patients in each group.LAPG group:Laparoscopic assisted proximal gastrectomy,LATC group:Laparoscopie assisted total gastrectomy.The data were processed by SPSS 22.0 software.Perioperative,nutritional status indicators and other measurement data were represented by(its),and independent 1 test was performed.Statistical data of complications were analyzed by χ^(2) tesl.K-M method and Log-Rank test were used for survival analysis.P<0.05 indiceated statistically significant difference.Results The operation time and lymph nodes dissection in LATG group were significantly higher than those in LAPG group,and the first exhaust time,first feeding time and postoperative hospitalization time were significantly lower than those in LAPC group,with statistieal signifieance(P<0.05).The incidence of postoperalive relux esophagitis in the LATG group was significantly lower than that in the LAPG group(6.7% vs.22.2%,P<0.05).There was no significant difference in Serum hemoglobin(Hb),total protein(TP),albumin(ALB)and other nutritional indexes between 2 groups 1 year after operation(P>0.05).The median follow-up was 72 months.Kaplan-Meier analysis showed that the 5-year overall survival rate of LATG group was 51.1%.and the disease-free survival rate was 42.2%:The 5-year overall survival rate and disease-free survival rate of LATG goup was 37.8%and 24.4%.There was significant iference in 5-year overall survival rate and disease-free survival rate between 2 groups(P<0.05).Conclusion Compared with LAPG,LATG treatment of Siewert Ⅱ AEC not only benefits postoperative recovery.reduces postoperative reflux esophagit

关 键 词：食管胃结合部腺癌 腹腔镜 全胃切除术 近端胃切除术 疗效比较研究 

分 类 号：R73[医药卫生—肿瘤]