不同胃切除及重建方式对近端为主胃癌患者预后及生存质量的影响

Impact of different gastrectomy and reconstruction methods on prognosis and quality of life in proximal gastric cancer

目的评估近端为主胃癌的两种胃切除、重建方式对其预后及生存质量的影响。方法选择中山大学胃癌诊治中心1994年8月至2011年1月期间近端为主胃癌265例，依手术或重建方式分为根治性近端胃切除／胃食管吻合组（radicalproximalgastrectomy，PG）（63例）、根治性全胃切除／食管空肠Roux—en-Y吻合组（radicaltotalgastrectomy，TG）（202例），比较2组的临床病理特征、预后及生存质量。结果2组患者性别、年龄、癌胚抗原（CEA）差异均无统计学意义（均P〉0．05）。PG组与TG组患者肿瘤直径（cm）（分别为2．9±1．9、4．8±2．8）及脏器侵犯率（分别为9．5％、32．2％）、淋巴结转移率（分别为64．7％、70．6％）、远处转移率（分别为0、8．4％）、TNM1V期（分别为6．9％、31．8％）、Borrmann浸润癌（分别为44．4％、69．2％）、低／未分化癌比例（分别为31．7％、53．7％），在TG组均显著高于PG组（t=-6．260，χ^2=29．473、14．559、5．665、32．483、12．588、10．954，均P〈0．05）。与PG组比较，TG组D3及以上根治者显著增多（分别为0、13．8％，χ^2=10．000，P=0．019），联合脏器切除率显著升高（分别为9．5％、38．6％，χ^2=18．770，P=0．000），而并发症发生率显著减少（分别为7．9％、1．5％，χ^2=6．778，P=0．009）。PG组与TG组中位生存期分别为62．5、78．9个月，差异无统计学意义（P〉0．05）。PG组与TG组的流质饮食（分别为44．4％、32．3％）、腹部不适（分别为30．2％、23．3％）、大便习惯或性状改变（分别为23．8％、18．3％）、体质量减轻（分别为30．6％、30．2％）、身体状况较差（分别为11．1％、9．0％）、劳动能力较差（23．8％、15．4％）差异均无统计学意义（均P〉0．05）。结论对近端为主胃癌，根治性全胃切除患者的TNM分期较近端胃切除者更晚，但两者预后相当；胃空肠吻合与食管空肠吻合的术后生存质量无明显差异。

Objective To evaluate the impact of different gastrectomy and reconstruction method on prognosis and quality of life in proximal gastric cancer. Methods The 265 cases of proximal gastric cancer received radical resection, according to gastrectomy or reconstruction method, were divided into proximal gastrectomy/gastroesophagostomy group （PC,） （ n = 63 ） and total, gastrectomy/esophagojeunostomy group （TG） （n =202）. The clinical pathologic features, prognosis, postoperative quality of life in 2 groups were compared. Results There had no significant differences in age, gender, CEA value between two groups （ all P 〉0. 05）. In PG and TG group, tumor size （ cm）, ratio of organic invasion, lymph nodes metastasis, distal metastasis, TNM IV stage, Borrmann typing, poor or undifferentiated carcinoma was 2. 9 ＋ 1.9 vs. 4.8＋2.8, 9.5% vs. 32.2%, 64.7% vs. 70.6%, 0 vs. 8.4%, 6.9% vs. 31. g%, 44.4% vs. 69.2%, 31.7% vs. 53.7%, respectively, all with significant difference （t = - 6. 260,χ^2 = 29. 473, 14. 559, 5. 665, 32. 483, 12. 588, 10. 954, all P 〈0. 05）. In PG and TG group, the ratio of D3 and D3 resection, multi-visceral resection, complications was 0 vs. 13.8%, 9. 5% vs. 38.6%, 7.9% vs. 1.5% respectively, showed increasing range of resection and decreasing complications significantly in TG group（all P 〈0. 05）. The median survival time （months） was 62. 5 vs. 78.9 in TG and PG group respectively, without significant difference （ P 〉 0. 05）. In 2 groups, the evaluation index of post-operative quality of life without significant differences （P 〉 0.05）. Conclusions For proximal gastric cancer, although the cases received TG with worse elinicopathological features, which prognosis was similar to that received PG. The postoperative quality of life without significant difference between the cases received gastroesophagostomy and esophagojejunostomy.