近端胃癌根治术中消化道重建两种新术式的初步研究

Two novel procedures for digestive tract reconstruction in proximal radical gastrectomy:a preliminary study

目的:探讨近端胃癌患者手术后消化道重建减少消化液反流发生的方法。方法:设计两种新型吻合方法,即保留贲门结构的食道-残胃吻合术和环状襻式单通道空肠间置术。将两种新术式临床效果与同传统的近端胃切除吻合和全胃切除相比较。结果:4组患者的临床病理资料具有可比性(P>0.05)。各组术后体质量和营养指数在6个月时无明显差异(P>0.05),在24个月时两种新术式组明显优高于传统吻合术组(P<0.05);在术后3年时的生存质量、食管反流的发病率和食管炎的Visick分级方面两种新术式组明显优于传统吻合术组(P<0.01);各组间的1,3,5年生存率差异均无统计学意义(P>0.05)。结论:保留贲门的近端胃癌根治术与环状襻式单通道空肠间置吻合术有望成为胃底贲门癌手术的新术式。

Objective： To investigate the methods of digestive tract reconstruction to reduce reflux in patients with proximal gastric cancer after gastrectomy. Methods： Two novel anastomosis procedures for proximal gastrectomy were designed, which were gastric cardia-preserving esophagogastrostomy and circular jejunal interposition pouch reconstruction. The clinical results of the two novel procedures were compared with those of the conventional proximal gastrectomy anastomosis and total gastrectomy. Results： The preoperative clinicopathologic data of the patients among the 4 groups were comparable （P〉0.05）. After surgery, the body weight and prognostic nutritional index on the 6th month had no significant differences among the groups （P〉0.05）, but both were significantly higher on the 24th month in the two groups with novel procedures than those in the groups with conventional procedures （P〈0.05）. The quality of life, incidence of esophageal reflux and Visick＇s grade of the two groups with new procedures were significantly better than those of the groups with conventional anastomoses at 3 years after surgery （P〈0.01）. There were no statistical differences among the 4 groups in the 1-, 3- and 5-year survival rate （P〉0.05）.Conclusion： The proximal gastrectomy with gastric cardia preservation and circular jejunal interposition pouch reconstruction are hopeful to become new procedures for surgical treatment of cancer of the gastric fundus and cardia.