近端胃癌根治术对进展期近端胃癌患者的远期影响

Long-term Effect of Proximal Radical Gastrectomy in Patients with Advanced Proximal Stomach Cancer

目的:探讨近端胃癌根治术对进展期近端胃癌(肿瘤直径>3 cm)患者的远期影响。方法:回顾性分析本院2005年7月-2010年7月近端胃癌患者170例,其中全胃切除术80例,近端胃癌根治术90例,调查术后5年生存率、术后营养状况、反流性食管炎发生率、术后胆囊结石发生率和生活质量。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和46个月,5年生存率分别为52.5%(42/80)和55.6%(50/90),比较差异无统计学意义(P=0.690)。近端胃癌根治组术后BMI与全胃切除组之间无显著统计学差异(P=0.064)。近端胃癌根治组术后血红蛋白、白蛋白、前白蛋白、维生素B12水平均显著高于全胃切除组,比较差异有统计学意义(P<0.05)。近端胃癌根治组术后反流性食管炎发生率11.1%(10/90),显著低于全胃切除组22.5%(18/80),比较差异有统计学意义(P=0.046)。近端胃癌根治组术后5年累计胆囊结石发生率8.9%(8/90),显著低于全胃切除组22.5%(16/80)(P=0.038)。近端胃癌根治组患者术后饮食情况、腹部症状均优于全胃切除组,比较差异有统计学意义(P<0.05)。结论:近端胃癌根治术较全胃切除术降低进展期近端胃癌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 investigate long-term effect of proximal radical gastrectomy in patients with advanced proximal gastric carcinoma. Method： 170 patients with advanced proximal stomach cancer were enrolled from July 2005 to July 2010 and divided into two groups, total gastrectomy group Contained 80 cases, and proximal radical gastrectomy group contained 90 cases. S-year survival rate, postoperative nutritional status, postoperative incidence of reflux esophagitis and cholecystolithiasis, quality of life between the two groups was compared. Result： Median survival time of the total gastrectomy group and the proximal radical gastrectomy group was 41 months and 46 months respectively. There was no significant difference in 5-year survival rate between the two groups （ P=0.690 ） . There was no significant difference in postoperative BMI between the two groups （ P=0.064 ） . Hemoglobin, albumin, pre-albumin, and vitarhin B12 of the proximal radical gastrectomy group was significantly higher than that of the total gastrectomy group （ P〈0.05 ） . Postoperative incidence of reflux esophagitis of the proximal radical gastrectomy group was 11.1% （ 10/90 ）, which was significantly lower than 22.5% （ 18/80 ） of the total gastrectomy group （ P=0.046 ） . Postoperative incidence of reflux cholecystolithiasis of the proximal radical gastrectomy group was 8.9% （ 8/90 ）, which was significantly lower than 22.5% （ 16/80 ） of the total gastrectomy group （ P=0.038 ） . Postoperative diet and abdominal symptom of the proximal radical gastrectomy group was better than that of the total gastrectomy group （ P〈0.05 ） . Conclusion： Proximal radical gastrectomy decrease postoperative incidences of reflux esophagitis and cholecystolithiasis, improve nutritional status and quality of life.