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。
Abstract
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 incidence 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 (χ2=0.440,P=0.803;χ2=0.234,P=0.890;χ2=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
Key words
stomach neoplasm /
radical operation for gastric cancer /
prognosis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 王士祺, 尚 琳, 赵青川, 等. 胃食管连接部切除后的消化道重建方式[J]. 中华胃食管反流病电子杂志, 2015, 2(1):48-49.
[2] 邹镇洪, 牟廷裕, 邓镇威, 等. 完全腹腔镜全胃切除胃癌根治术消化道重建方式的探讨[J]. 中华胃肠外科杂志, 2014, 17(8):844.
[3] Liese A D, Ma X G, Maahs D M, et al. Physical activity, sedentary behaviors, physical fitness, and their relation to health outcomes in youth with type 1 and type 2 diabetes:a review of the epidemiologic literature[J]. J Sport Health Sci, 2013, 2(1):21-38.
[4] Chu F Y, Wang J, Yao K W, et al. Effect of Xuefu Zhuyu Capsule on the symptoms and signs and health-related quality of life in the unstable angina patients with blood-stasis syndrome after percutaneous coronary intervention: a randomized controlledtrial[J]. Chin J Integr Med, 2010, 16(5):399-405.
[5] Tokunaga M,Ohyama S,Hiki N,et al. Endoscopic evaluation of reflux esophagitis after proximal gastrectomy: comparison between esophagogastric anastomosis and jejunal interposition[J]. World J Surg, 2008, 32(7) : 1473-1477.
[6] 李林浩, 马 雷, 肖永来, 等. 胃癌近端胃大部切除术消化道重建方式的临床观察[J]. 中华医学杂志, 2011, 91(14):961-964.
[7] Addo-Yobo E, Anh D D, El-Sayed H F, et al. Outpatient treatment of children with severe pneumonia with oral amoxicillin in four countries the MASS study[J].Trop Med Int Health,2011,16(8):995-1006.
[8] 院存珍,樊 晨.胃癌外科的综合治疗研究进展[J].中华临床医师杂志,2015,9(1):111-113.
[9] Gacci M, Saleh O, Cai T, et al. Quality of life in women undergoing urinary diversion for bladder cancer: results of a multicenter study among long-term disease-free survivors[J]. Health Qual Life Outcomes,2013,11:11-43.
[10] 冯黎明. Roux-en-Y吻合在远端胃癌根治术后消化道重建的应用[J]. 中国医药导报, 2013, 10(35):62-64.
[11] Souli M, Galani I, Antoniadou, et al. An outbreak of infection due to beta-Lactamase Klebsiella pneumoniae Carbapenemase 2-producing K. pneumoniae in a Greek University Hospital: molecular characterization, epidemiology, and outcomes[J]. Clin Infect Dis,2010, 50(3):364-373.
[12] Zhang X, He Y, Ding M. Simultaneous determination of tryptophan and kynurenine in plasma samples of children patients with Kawasaki disease by high-performance liquid chromatography with programmed wavelength ultraviolet detection[J]. J Chromatogr B Analyt Technol Biomed Life Sci, 2009, 877(16/17):1678-1682.
[13] Druyts E, Thorlund K, Humphreys S, et al. Interpreting discordant indirect and multiple treatment comparison meta-analyses: an evaluation of direct acting antivirals for chronic hepatitis C infection[J]. Clin Epidemiol, 2013, 5:173-183.
[14] Zhang P, Li C, Li Y, et al. Proteomic identification of differentially expressed proteins in sea cucumber Apostichopus japonicus coelomocytes after Vibrio splendidus infection[J]. Dev Comp Immunol, 2014,44(2):370-377.
PDF(600 KB)
