近端胃切除与全胃切除对SiewertⅡ型和Ⅲ型食管胃结合部腺癌疗效的比较

A comparison study of total gastrectomy versus proximal gastrectomy for Siewert Ⅱ and Ⅲ adenocarcinomas of the esophagogastric junction

目的对比研究全胃切除术和近端胃切除术治疗SiewertⅡ、Ⅲ型食管胃结合部腺癌(AEG)的疗效。方法回顾性分析2007年12月至2009年12月徐州医学院附属淮安医院普外科收治的105例SiewertⅡ、Ⅲ型AEG患者的临床资料,其中近端胃切除术组(PG组)32例,全胃切除术组(TG组)73例。分析比较两组患者临床病理特征、围术期情况、胃食管反流情况、生命质量及生存情况。患者采用电话或者门诊复查方式进行随访。随访时间截止2014年12月。结果 PG组患者平均手术时间为(2.35±0.05)h,短于TG组的(3.17±0.04)h,平均术中出血(183.6±8.74)ml,少于TG组的(256.2±10.41)ml(P<0.05)。两组患者围术期并发症和术后住院时间的差异均无统计学意义(P>0.05)。TG组和PG组术后1年胃食管反流病问卷(GERD-Q)评分分别为(8.18±2.3)分和(12.59±2.40)分,两组比较差异有统计学意义(P<0.05)。两组患者在术后1年的BMI、血红蛋白、白蛋白指标差异无明显统计学意义(P>0.05)。两组患者术后5年生存率的差异无统计学意义(P>0.05)。结论根治性全胃、近端胃切除术两组5年生存率差异无统计学意义。近端胃切除并不能改善患者的营养状态,全胃切除在降低胃食管反流方面优于近端胃切除,是目前SiewertⅡ、Ⅲ型AEG患者较为合适的手术方式。

ObjectiveTo compare the effect of total gastrectomy （TG） and proximal gastrectomy （PG） for SiewertⅡ,Ⅲ type adenocarcinomas of the esophagogastric junction （AEG）. Methods The clinical data of 105 patients of SiewertⅡ andⅢ type AEG from December 2007 to December 2009 were analyzed retrospectively. All the patients were divided into the TG group （73 cases） and the PG group （32 cases）. The clinicopathological features, perioperative, gastroesophageal reflux, quality of life and survival were compared between the two groups. Patients were followed up by telephone or out-patient examination till December 2014.Results The average operation time was （2.35±0.05） h in PG group, shorter than the TG group （3.17±0.04） h. The average intraoperative bleeding was （183.6±8.74） ml in PG group, less than the TG group （256.2±10.41） ml （P〈0.05）. There were no significant differences in post operation complications and hospital stay of the two groups （P〉0.05）. The gastroesophageal reflux disease questionnaire （GERD-Q） scores at postoperative 1 year of TG group and PG group were （8.18±2.3） scores and （12.59±2.40） scores, with significant difference between the two groups （P〈0.05）. There were no significant differences in BMI, hemoglobin, albumin at postoperative 1 year and postoperative 5 years survival rate of the two groups （P〉0.05）.ConclusionThere was no significant difference in the 5-year survival rates between the two groups. Proximal gastrectomy did not improve the nutritional status of patients. Total gastrectomy in reducing gastroesophageal reflux is better than that of proximal gastrectomy, is currently suitable operation mode of the SiewertⅡ,Ⅲ AEG patients.