“管状”胃食管吻合在近端胃癌根治术消化道重建中的对比研究

Comparative study of the two different tube-like esophagogastric anastomasis approaches to gastric reconstruction for patients undergone proximal gastrectomy

目的:探讨"管状"胃食管吻合在进展期近端胃癌根治术消化道重建方式中的应用价值。方法:选择进展期贲门癌患者66例,分别施行"管状"胃-食管吻合的根治性近端胃大部切除术(实验组34例)和食管-空肠Roux-en-Y吻合的根治性全胃切除术(对照组32例),比较两组患者的手术时间、淋巴结清扫、围手术期并发症以及术后2年消化道症状、体质量、近期存活率。结果:实验组和对照组淋巴结清扫、术中出血量、住院时间及术后并发症,差异无统计学意义;经2年随访,两组均无复发和死亡病例;平均手术时间实验组长于对照组;术后生活质量及营养状况比较,实验组优于对照组,差异有统计学意义。结论:对于进展期贲门癌患者,施行"管状"胃-食管吻合的根治性近端胃大部切除术不会降低其近期生存率,且可改善生活质量。

Objective：To assess the clinical value of applying tube-like esophagogastric anastomasis approaches to gastric reconstruction for pa-tients undergone gastrectomy due to advanced proximal gastric cancer . Methods：Sixty-six patients with advanced gastric cardia cancer were in-cluded and received either proximal subtotal gastrectomy with gastric tube-like esophagogastric anastomasis（ n=34,Test group） or total gastrectomy with Roux-en-Y esophagojejunal anastomosis（n=32,Control group）.The two groups were compared concerning the operative time ,lymph node dis-section, occurrence of perioperative complications, and gastrointestinal symptoms in two years after operation, weight loss and recent survival rate.Results：The two groups remained no significant difference regarding the lymph node dissection,intraoperative blood loss,length of hospital stay and postoperative complications.Two years of follow-up showed no relapse or death in the two groups,yet the test group required less operative time and had better quality of life and nutritional status after operation than the control group,which suggested statistical difference.Conclusion：Patients with advanced carcinoma of gastric cardia undergone proximal subtotal gastrectomy with tube-like esophagogastric anastomasis will not reduce the recent survival rate,yet may improve their quality of life.