Siewert Ⅱ/Ⅲ型食管胃结合部腺癌全胃与近端胃切除术临床效果及影响预后因素分析

The clinical effect of Siewert Ⅱ and Ⅲ adenocarcinoma of gastro-esophageal junction(AEG) full stomach and proximal gastrectomy,and the influencing factors after the intervention

目的探讨SiewertⅡ／Ⅲ型食管胃结合部腺癌（adenocarcinoma of gastro-esophageal junction，AEG）全胃与近端胃切除术的临床效果及预后的影响因素。方法对2008-2010年福建省立医院收治的140例SiewertⅡ／Ⅲ型AEG患者的临床资料进行回顾性分析，比较全胃切除术与近端胃切除术临床效果及分析影响AEG复发的因素。结果全胃切除术组民切除例数、远端切缘长度、淋巴结清扫数目、阳性淋巴结检出数均高于近端胃切除术组（均P〈0．05）。全胃切除术组在肠鸣音恢复时间、肛门排气时间、进食时间、术后住院时间、胃液TBi1、胃液IBi1、胃液胆汁酸、术后抗生素应用时间均短（低）于近端胃切除术组（均P〈0．05）。肿瘤大小、分化程度、浸润深度、术后血清CEA水平、术中淋巴结清扫数目、阳性淋巴结检出数目、R1切除例数是SiewertⅡ／Ⅲ型AEG术后复发的危险因素（β=0．30～0．52），相对危险度1．91—3．12。结论全胃切除术治疗SiewertⅡ／Ⅲ型AEG的效果及术后生活质量均优于近端胃切除术。

Objective Explore the clinical effect of Siewert Ⅱ and Ⅲ adenocarcinoma of gastro-esophageal junction（AEG） full stomach and proximal gastrectomy, and the influencing factors after the intervention. Methods From 2008 to 2010, in Fujian province hospital, 140 cases of Siewert Ⅱand Ⅲ AEG patients as clinical data were retrospectively analyzed, comparing total gastrectomy and clinical effect of proximal gastrectomy, analysis the influencing factors of AEG recurrence. Results Total gastrectomy group R0, the resection cases, distal cut edge length, number of lymph node cleaning, positive lymph nodes, which were higher than in proximal gastrectomy group （ P 〈 0.05 ）. Total gastrectomy group in bowel sound recovery time, anus exhaust time, eating time, length of hospital stay, postoperative gastric TBil, IBil gastric juice, gastric juice bile acid, postoperative antibiotics application time than proximal gastrectomy group （ P 〈 0. 05 ）. Tumor size, differentiation degree, infiltration depth, postoperative serum CEA levels, intraoperative lymph node cleaning the number, number of positive lymph nodes detection, R1 resection cases are the risk factors of Siewert ⅡandⅢ AEG postoperative recurrence （β = 0. 30 -0. 52）, the relative risk 1.91 -3.12. Conclusions The treatment effect and the postoperative quality of life of total gastrectomy is better than that of the proximal gastrectomy.