两种胃切除术式对进展期近端胃癌预后的影响分析

Prognostic analysis of two types of gastrectomy for advanced proximal gastric cancer

目的比较全胃切除和近端胃切除对进展期近端胃癌预后的影响。方法回顾分析2008年1月至2012年3月就诊的172例进展期近端胃癌患者的临床病理资料,按不同的手术方式分为近端胃切除组(83例)和全胃切除组(89例);观察并记录患者手术情况、术后并发症等情况,并对患者出院后生存、肿瘤复发、转移等情况进行为期5年的随访。采用SPSS 24.0统计软件进行数据分析,年龄、手术时间、术中出血量等计量资料采用(x珋±s)表示,比较采用独立t检验;性别、肿瘤部位等无序二分类资料采用卡方检验,肿瘤大小浸润深度等有序二分类资料采用秩和检验;生存分析采用Kaplan-Meier法,以P<0.05为差异有统计学意义。结果全胃切除组患者手术时间、术中出血量较近端胃切除组患者偏高,其余术中及术后情况差异无统计学意义。全胃切除组患者术后胃排空障碍、吻合漏和反流性食管炎的发生率较近端切除组患者显著偏低(P<0.05)。术后1年、3年、5年生存率,近端切除组患者分别为71.1%、45.5%和34.2%明显低于全胃切除组83.1%、67.2%和56.6%;(F=10.746,P=0.001)。结论全胃切除能减少对进展期近端胃癌术后并发症的发生率,并延长患者术后生存时间。

Objective To compare the clinical outcome of total gastrectomy and proximal gastrectomy for advanced proximal gastric cancer. Methods From January 2008 to March 2012,clinical data of 172 patients with advanced proximal gastric cancer in our hospital were analyzed retrospectively.According to operation methods,172 patients were divided into proximal gastrectomy group(83 cases)and total gastrectomy group(89 cases).The operation data and complications of the patients were observed and recorded,and the survival,recurrence and metastasis of the patients were followed up for 5 years.SPSS24.0 statistical software was used for data analysis,Measurement data such as age,time of operation and amount of bleeding during operation were presented as(±s)and were examined by t test.Gender,tumor location and other disorder two classification data were examined by using chi square test,Tumor size,depth of infiltration and other ordered two categorical data were examined by rank sum test;Kaplan-Meier method was used by survival analysis.P<0.05 was thought to be statistically significant. Results The operation time and the amount of bleeding of patients underwent total gastrectomy were more than those of patients underwent proximal gastrectomy(P<0.05).However,there was no significant difference between 2 groups in terms of other intraoperative and postoperative indicators.Compared with proximal gastrectomy,patients received total gastrectomy had significantly lower incidence of complications such as gastric emptying dysfunction,leakage and reflux esophagitis(P<0.05).1 year,3 year and 5 year survival in proximal resection group were 71.1%,45.5%and 34.2%,respectively,which were significantly lower than 83.1%,67.2%and 56.6%in total gastrectomy group(F=10.746,P=0.001). Conclusion Total gastrectomy could reduce the incidence of postoperative complications,and prolong the postoperative survival.