食管胃结合部腺癌根治术两种消化道重建方式的临床比较

Clinical Comparison of Two Kinds of Digestive Tract Reconstruction after Cardia Radical Mastectomy

目的 探讨食管胃结合部腺癌根治术后消化道重建的较为理想的术式.方法 选自2005年1月～2011年1月308例进展期Ⅱ型、Ⅲ型食管胃结合部腺癌根治术病人,进行了两种不同的消化道重建方式,对术后并发症、手术时间、死亡例数、术后半年各种营养指标及术后生活质量进行比较观察.结果 两种消化道重建方式在术后并发症、手术时间及手术相关病死率方面没有统计学差异（P＞0.05）,在术后半年营养指标方面,3S空肠间置组明显优于Roux-en-Y食管空肠吻合组（P＜0.05）.3S空肠间置组在预防反流性食管炎及倾倒综合征发生方面,明显优于食管空肠吻合组（P＜0.05）.该组患者术后营养状况良好,生活质量高.结论 3S空肠间置消化道重建术是食管胃结合部腺癌根治术后较为理想的重建术式.

Objective To explore the ideal procedure of digestive tract reconstruction after radical operation for gastroesophageal junction adenocarcinoma.Methods From January 2005 to January 2011,the two different types of digestive tract reconstruction were adopted in 308 cases of advanced Ⅱ type,Ⅲ type of esophageal gastric junction adenocarcinoma.The complications,operation time,mortality,nutrition index after six months and quality of life were evaluated.Results There was no significant difference between the two procedures in complications,operation time and operation related mortality （P ＞ 0.05）.At the timepoint-6th months post operation,the nutrition index in 3S type group was obviously better than the group of Roux-en-Y type （P ＜ 0.05）.3S type group in prevention of reflux esophagitis and dumping syndrome,was superior to the group of Roux-en-Y type （P ＜ 0.05）.Compared with Roux-en-Y reconstruction,the 3S reconstruction type had better nutritional status and higher quality of life.Conclusion 3S type tract reconstruction is an ideal reconstruction after radical surgical procedures for gastroesophageal junction adenocarcinoma.