Siewert Ⅱ/Ⅲ型食管胃结合部腺癌不同重建方式对预后的影响

Different reconstruction on the prognosis of Siewert Ⅱ/Ⅲ adenocarcinoma in esophagogastric junction

目的观察免疫肠内营养对SiewertⅡ/Ⅲ型食管胃结合部腺癌患者接受不同重建方式后恢复、免疫功能、营养状况、生存质量的影响。方法将42例SiewertⅡ/Ⅲ型食管胃结合部腺癌患者随机分为PG+空肠间置组和TG组,手术后均采取免疫肠内营养治疗。检测术前1天、术后5天相关的营养和免疫血清指标,比较和分析术后恢复情况、生存质量和免疫功能、营养状况。结果 PG+空肠间置组和TG组手术后肠道通气时间、术后5天体重变化、腹腔感染、吻合口瘘等并发症的发生无显著差异。术后5天检测PG+空肠间置组血清总蛋白、清蛋白、前清蛋白、IgG、IgA水平以及CD3^+、CD4^+、CD4^+/CD8^+与TG组比较,无显著差异(P>0.05)。术后12个月PG+空肠间置组术后体重变化、血红蛋白较TG组明显改善(P<0.05)。PG+空肠间置组和TG组反流症状发生率均较低(P>0.05)。结论早期使用免疫肠内营养,对比SiewertⅡ/Ⅲ型食管胃结合部腺癌患者行PG+空肠间置术后和TG术后的营养状况和免疫功能,证明PG+空肠间置组显优势。

Objective To compare the effects of enteral immunonutrition on recovery,nutritional status,immune function,quality of life in patients with Siewert II/III adenocarcinoma of esophagogastric junction received proximal gastrectomy plus jejunal interposition versus total gastrectomy.Methods42cases of Siewert II/III adenocarcinoma of esophagogastric junction patients were randomly divided into proximal gastrectomy plus jejunal interposition group(PG)and total gastrectomy group(TG).Postgastrectomy enteral immunonutrition therapy was early used in two groups.The changes of recovery,serum markers,nutritional status,immune function were evaluated on1st day and5th day postoperation.Quality of life were compared in12months postoperation.ResultsThere were no significant difference neither in postoperative complications nor in levels of serum total protein,albumin,prealbumin and IgG,IgA,CD3+,CD4+,CD4+/CD8+between2groups on the5th day postoperation(P>0.05).The levels of weight loss andhemoglobin in PG+jejunal interposition group was significantly increased(P<0.05)than TG group on12months after operation,no significant difference was seen in reflux symptoms between2groups.Conclusions Early usage of enteral immunonutrition in Siewert II/III adenocarcinoma of esophagogastric junction received PG+jejunal interposition can improve recovery,nutritional status and enhance immunity.PG+jejunal interposition was better than TG in postgastrectomy function reservation and life quality.