近端胃癌根治术应用效果观察

Applicability of proximal radical gastrectomy in patients with proximal stomach cancer

目的探讨全胃切除术与近端胃癌根治术对进展期近端胃癌(肿瘤直径>3 cm)患者术后并发症、营养状况和生活质量的影响。方法回顾性分析我院2002年1月至2008年12月近端胃癌患者85例,其中全胃切除术40例,近端胃癌根治术45例,调查术后营养状况、反流性食管炎发生率、术后胆囊结石发生率、5年生存率和术后生活质量。两组患者性别、年龄、肿瘤直径、手术时间、住院时间、住院费用、淋巴结清扫数目、术前营养指标和术后并发症均无统计学差异。结果全胃切除组和近端胃癌根治组患者中位生存期分别为41个月和46个月,5年生存率分别为52.5%(21/40)和55.6%(25/45),均无显著统计学差异(P>0.05)。全胃切除组和近端胃癌根治组术后反流性食管炎发生率分别为25.0%(10/40)和8.9%(4/45),有显著的统计学差异(P<0.05)。全胃切除组和近端胃癌根治组患者术后5年累计胆囊结石发生率分别为27.5%(11/40)和8.9%(4/45),有显著的统计学差异(P<0.05)。近端胃癌根治组术后血红蛋白、白蛋白、维生素B12和铁蛋白均显著高于全胃切除组,有统计学差异(142.2±10.6 vs.128.4±11.4;41.3±5.8vs.35.9±3.8;271.5±39.7 vs.184.5±24.6;220.2±59.7 vs.170.2±27.6;P<0.05)。近端胃癌根治组患者术后饮食情况和劳动情况均优于全胃切除组,有显著的统计学差异(P<0.05)。结论近端胃癌根治术不影响进展期近端胃癌(肿瘤直径>3 cm)患者5年生存率,可以降低术后反流性食管炎和胆囊结石发生率,改善术后营养状况和生活质量。

Objective To compare complications, nutritional status and quality of life between total gastrectomy and proximal radical gastrectomy in patients with advanced proximal gastric carcinoma. Methods Eighty-five patients with proximal stomach cancer were enrolled from Jan 2002 to Dec 2008 and：underwent total gastrectomy （total gastrectomy group,n =40） and proximal radical gastrectomy （proximal radical gastrectomy group, n=45 ）. Nutritional status, incidence of reflux esophagitis and cholecystolithiasis, 5-year survival rate, quality of life were investigated. Results Median survival time of total gastrectomy group and proximal radical gastrectomy group were 41 months and 46 months respectively. There was no significant difference in 5-year survival rate between two groups （P〉0.05）. There was significant difference in incidence of reflux esophagitis between total gastrectomy group and proximal radical gastrectomy group （10/40, 25% vs. 4/45, 8.9%, P〈0.05）. There was significant difference in incidence of cholecystolithiasis between total gastrectomy group and proximal radical gastrectomy group （11/40, 27.5% vs. 4/45, 8.9%,P〈0.05）. Hemoglobin, albumin, vitamin B12 and ferritin in proximal radical gastrectomy group were higher than those in total gastrectomy group （142.2±10.6 vs. 128.4±11.4; 41.3±5.8 vs. 35.9±3.8; 271.5±39.7 vs. 184.5±24.6; 220.2±59.7 vs. 170.2±27.6; P〈0.05 ）. Diet and labor in proximal radical gastreetomy group were better than those in total gastrectomy group （P〈0.05）. Conclusion Proximal radical gastrectomy decreases incidence of reflux esophagitis and choleeystolithiasis, improve nutritional status and quality of life.