不同消化道重建手术方案对近端胃癌根治术远期预后的影响分析  

Analysis of the influence of different digestive tract reconstruction schemes on the long-term prognosis of radical gastrectomy for proximal gastric cancer

作　　者：杨帆 YANG Fan(First Department of Surgery,Ganxi Cancer Hospital,Pingxiang 337000,China)

机构地区：[1]萍乡赣西肿瘤医院外一科,337000

出　　处：《中国现代药物应用》2025年第3期34-37,共4页Chinese Journal of Modern Drug Application

摘　　要：目的探讨不同消化道重建手术方案对近端胃癌根治术远期预后的影响。方法100例行近端胃癌根治术的患者,按照消化道重建手术方案的不同分成A组(n=31)、B组(n=33)及C组(n=36)。A组实施全胃切除加Roux-en-Y食管空肠吻合术,B组实施近端胃切除加食管残胃吻合术,C组实施近端胃切除加空肠功能性间置术。对比三组患者临床病理特征、术后1年胃肠道症状发生情况、术后1年营养状况以及生存率。结果三组年龄、性别、分化程度、浸润深度、淋巴结转移情况比较,无差异(P>0.05);三组肿瘤直径、Borrmann分型、临床分期比较,差异显著(P<0.05)。A组术后1年胃肠道症状发生率为25.81%,B组为30.30%,C组为5.56%。三组术后1年胃肠道症状发生率比较,差异显著(P<0.05);C组术后1年胃肠道症状发生率比A组、B组低,差异显著(P<0.05)。A组术后1年体质量变化率、血红蛋白变化率、血清白蛋白变化率分别为(-9.6±5.9)%、(-4.5±4.7)%、(-3.8±3.2)%,B组分别为(-7.8±4.3)%、(-0.4±3.9)%、(1.1±5.4)%,C组分别为(-8.2±4.1)%、(-0.9±5.3)%、(-0.3±4.5)%。三组术后1年血红蛋白变化率、血清白蛋白变化率比较,差异显著(P<0.05);三组术后1年体质量变化率比较,无差异(P>0.05)。A组术后1年血红蛋白变化率、血清白蛋白变化率比B组、C组明显,差异显著(P<0.05)。三组术后0.5、1、2年的生存率比较,无差异(P>0.05)。结论针对胃癌患者,使用近端胃切除加空肠功能性间置的手术方案,相比于使用全胃切除加Roux-en-Y食管空肠吻合术以及近端胃切除加食管残胃吻合术,其胃肠道症状发生发生较少,营养状况较好,三种手术方案生存率均较高。Objective To explore the influence of different digestive tract reconstruction schemes on the long-term prognosis of radical gastrectomy for proximal gastric cancer.Methods A total of 100 patients with proximal gastric cancer who underwent radical gastrectomy were divided into group A(n=31),group B(n=33)and group C(n=36)according to different surgical plans of digestive tract reconstruction.Group A(n=31)used total gastrectomy plus Roux-en-Y esophagojejunal anastomosis,group B(n=33)used proximal gastrectomy plus esophagogastric anastomosis,and group C(n=36)used proximal gastrectomy plus functional jejunal interposition.The clinicopathological features,gastrointestinal symptoms,nutritional status and survival rate at 1 year after surgery were compared among the three groups.Results There were no differences in age,gender,degree of differentiation,depth of invasion and lymph node metastasis among the three groups(P>0.05).There were significant differences in tumor diameter,Borrmann classification and clinical staging among the three groups(P<0.05).The incidence of gastrointestinal symptoms at 1 year after surgery was 25.81% in group A,30.30% in group B,and 5.56% in group C.The incidence of gastrointestinal symptoms was significantly different among the three groups at 1 year after surgery(P<0.05).The incidence of gastrointestinal symptoms in group C at 1 year after surgery was significantly lower than that in group A and group B(P<0.05).The decrease rates of body mass,hemoglobin and serum albumin of group A at 1 year after operation were(-9.6±5.9)%,(-4.5±4.7)% and(-3.8±3.2)%,those of group B were(7.8±4.3)%,(0.4±3.9)% and(1.1±5.4)%,and those of group C were(8.2±4.1)%,(0.9±5.3)% and(0.3±4.5)%.The decrease rates of hemoglobin and serum albumin at 1 year after surgery were significantly different among the three groups(P<0.05).There was no difference in the decrease rate of body mass at 1 year after surgery among the three groups(P>0.05).The changes of hemoglobin and serum albumin in group A at 1 year after sur

关 键 词：近端胃癌根治术 全胃切除术 食管残胃吻合 空肠功能性间置 远期预后 

分 类 号：R735.2[医药卫生—肿瘤]