贲门癌不同术式的前瞻性随机临床研究

A prospective randomized clinical study of different operations performed for cardia carcinoma

目的 通过前瞻性随机临床研究来探讨贲门癌的术式选择。方法 将 84例贲门癌患者随机分为两组 ,一组行全胃切除术 (TG) ,另一组行近侧胃大部切除术 (STG) ,分别于术后 1个月 ,3个月 ,12个月进行随访 ,要求患者根据随访表并测定相应指标。结果 84例患者中 ,术前和术后 1个月两组间各项指标差异无显著性。术后 3、12个月 ,在食量、灼心感、体重减轻等方面 ,TG组优于STG组 ,差异有显著性 (P <0 0 5 ) ,其他症状与Spitze评分中 ,TG组与STG组比较 ,差异无显著性。TG组与STG组的营养指标在术后均有下降 ,但随时间延长都逐渐上升 ,TG组与STG组在术后 1个月的比较 ,差异无显著 ,在 3、12个月 ,TG组的营养指标比STG组改善更明显 ,差异有显著性 (P <0 0 5 )。TG组手术时间比STG组要长 ,差异有显著性 (P <0 0 5 ) ,出血量相仿 ,TG组术后出现并发症与STG组比较 ,差异无显著性。结论 贲门癌的基本术式应该是全胃切除术 ,术后患者的生活质量、营养状态、临床疗效均能达到满意的效果。

Objective The purpose of this study was to perform a prospective randomized clinical trial comparing total gastrectomy (TG) and proximal subtotal gastrectomy (STG) for the treatment of cardiac carcinoma Methods Eighty four patients with cardiac carcinoma,who were randomized into the two operative options, were enrolled Patients were followed up for 1, 3, 12 months postoperatively Results There were no significant differences in body weight, nutrition status and symptoms between the two groups one month postoperatively ( P >0 05) There were no significant differences in Spitzer scoring at 3, 12, months postoperatively between TG and STG groups ( P >0 05) TG patients had a better quality of life especially in appetite, heartburn and weight loss at 3, 12 months postoperatively than STG The nutrient marker of all patients fell immediately after operation As with time, nutrition status improved in all patients, TG patients were on a better nutrition status 3, 12 months after postoperatively than STG patients ( P <0 05) The time of TG operation is longer than STG ( P <0 05) There were neither significant differences in the volume of hemorrhage in the operation nor in the complication postoperatively between TG and STG groups ( P >0 05) Conclusion Patients with cardiac carcinoma should be recommended to receive total gastrectomy