两种不同手术方式在近端胃癌根治术中的应用

Application of two different gastrectomy methods in proximal gastric cancer

目的：探讨近端胃癌两种不同手术方式对患者术后生命质量、并发症和预后的影响。方法回顾性分析中山大学附属东华医院收治的102例近端胃癌患者临床资料，其中50例行近端胃癌根治性切除，残胃食管吻合（近端胃切除组）；52例行全胃切除，食管空肠 Roux-en-Y 吻合（全胃切除组）。比较两组的术后并发症、营养指标以及预后情况。结果两组患者术后反流性食管炎比较，近端胃切除组与全胃切除组发生率分别为38．0％和19．2％，差异有统计学意义（χ2＝4．464，P ＝0．035）。术后感染、出血、吻合口瘘发生率两组比较差异均无统计学意义（χ2＝0．063，P ＝1．000；χ2＝0．001，P ＝0．978；χ2＝0．311，P ＝0．577）。术后1年两组血浆总蛋白分别为（65．26±4．10）g／L、（65．33±3．75）g／L，白蛋白分别为（39．76±2．17）g／L、（39．59±2．04）g／L，血 红 蛋白分别为（107．33 ± 11．10）g／L、（108．09±11．17）g／L，术后体重分别减轻1．00～8．00 kg、0．50～8．20 kg，两组比较差异均无统计学意义（t ＝－0．402，P ＝0．688；t ＝1．778，P ＝0．076；t ＝－1．502，P ＝0．133；t ＝－1．622，P ＝0．105）。术后随访时间7个月至10年，两组术后吻合口复发率分别为4．0％和5．8％，肿瘤远处转移发生率分别为24．0％和28．8％，差异均无统计学意义（χ2＝0．171，P ＝0．679；χ2＝0．308，P ＝0．579）。两组中位生存期分别为53．6个月和49．8个月，生存率比较差异无统计学意义（χ2＝2．564，P ＝0．109）。结论与近端胃切除相比，全胃切除可有效减少术后反流性食管炎的发生，且不增加营养不良、肿瘤复发转移及死亡的发生率，是一种安全有效的手术方式。

Objective To evaluate the impacts of the two different gastrectomy methods on the quality of life,complication and prognosis in proximal gastric cancer.Methods One hundred and two cases of proximal gastric cancer in Tung Wah Hospital were collected for retrospective analysis.They were divided into proximal gastrectomy/gastroesophagostomy （PG）group （n =50）and total gastrectomy/esophagojejunostomy （TG） group （n =52）,according to the methods of gastrectomy and reconstruction.The postoperative complications, nutritional status and prognosis of the two groups were compared.Results The incidence of reflux esophagitis was obviously higher in PG group than that in TG group （38.0% vs 1 9.2%,χ^2 =4.464,P =0.035）.No sig-nificant differences were found between the two groups in the incidences of postoperative infection,bleeding and anastomotic leakage （χ^2 =0.063,P =1 .000;χ^2 =0.001 ,P =0.978;χ^2 =0.31 1 ,P =0.577）.There were no significant differences between PG and TG group in total plasma protein [（65.26 ±4.1 0）g/L vs （65.33 ± 3.75）g/L,t =-0.402,P =0.688],albumin [（39.76 ±2.1 7）g/L vs （39.59 ±2.04）g/L,t =1 .778,P =0.076],hemoglobin [（1 07.33 ±1 1 .1 0）g/L vs （1 08.09 ±1 1 .1 7）g/L,t =-1 .502,P =0.1 33]and weight loss [1 .00 -8.00 kg vs 0.50 -8.20 kg,t =-1 .622,P =0.1 05]in one year postoperatively.All cases were followed-up for 7 months to 1 0 years.No significant differences were found between PG and TG group in the incidences of anastomotic tumor recurrence （4.0% vs 5.8%,χ^2 =0.1 71 ,P =0.679）,metastasis （24.0% vs 28.8%,χ^2 =0.308,P =0.579）and median survival time （53.6 months vs 49.8 months,χ^2 =2.564,P =0.1 09）.Conclusion Compared with PG group,the incidence of postoperative reflux esophagitis is effectively＆amp;nbsp;reduced,and the incidences of malnutrition,tumor recurrence and metastasis and death are not increased in TG group.Hence,TG should be a safe and effective surgery strategy.