窄管状胃食管吻合对高龄SiewertⅡ型食管胃结合部腺癌患者的近期疗效

Application of narrow tubular gastroesophageal anastomosis in elderly patients with Siewert Ⅱ esophagogastric junction adenocarcinoma and its short-term curative effect

目的分析窄管状胃食管吻合对高龄(>70岁)SiewertII型食管胃结合部腺癌(AEG)患者的近期疗效.方法回顾分析郑州大学附属肿瘤医院胃肠外科2017年1月至2018年1月收治的37例高龄SiewertII型AEG患者的临床资料,37例均行根治性近端胃切除加食管窄管状胃(内径约2.5cm)吻合术并作为管胃组;收集同期收治的31例高龄行根治性全胃切除的SiewertII型AEG患者的临床资料,将其并作为全胃组.分析比较两组患者术前营养状况、肺功能,术中出血、吻合口瘘,术后肺部感染、排气时间、淋巴结清扫数目、阳性淋巴结数目,停止化疗后6个月或术后6个月营养状况及胃食管反流情况和吻合口狭窄情况.结果两组患者年龄、性别、术前肺功能等临床资料比较差异未见统计学意义(P<0.05);管状胃组术前血红蛋白、白蛋白,术后肺炎、吻合口瘘、吻合口狭窄发生率,淋巴结清扫数目、阳性淋巴结数目,与全胃组比较,差异均未见统计学意义(P均>0.05);术后6个月或停止化疗后6个月两组反流症状评分、内镜下食管黏膜情况比较,差异未见统计学意义(P>0.05).管状胃组手术时间较全胃组缩短27min(P<0.001)、术中出血减少11.1ml(P=0.015)、排气时间提前1.6d(P<0.001);术后6个月或停止化疗后6个月管状胃组较全胃组血红蛋白高8.8g/L(P<0.001)、白蛋白高4.1g/L(P=0.020).结论在高龄食管胃结合部腺癌患者中应用窄管状胃食管吻合的手术方式可缩短手术时间、减少术中出血,改善术后营养状况,且并不增加术后反流性食管炎发生率,是一种安全可行的消化道重建方式.

Objective To analyze the short-term efficacy of narrow-tube gastroesophageal anastomosis in elderly(>70 years old)Siewert II esophagogastric adenocarcinoma(AEG)patients.Methods Retrospective analysis of clinical data of 37 elderly patients with Siewert II AEG admitted to Department of Gastrointestinal Surgery,Tumor Hospital Affiliated to Zhengzhou University from January 2017 to January 2018,37 cases were treated with radical proximal gastrectomy and esophagogastric narrow tube stomach(diameter 2.5 cm)anastomosis and served as gastric tube group.The clinical data of 31 elderly patients with Siewert II AEG who underwent radical total gastrectomy during the same period were collected and treated as the whole stomach group.The nutritional status,pulmonary function,intraoperative bleeding,anastomotic leakage,pulmonary infection,exhaust time,number of lymph node dissection,number of positive lymph nodes,nutritional status,gastroesophageal reflux and anastomotic stenosis were analyzed and compared between the two groups.Results There was no significant difference in age,sex and preoperative pulmonary function between the two groups(P<0.05).There was no significant difference in preoperative hemoglobin,albumin,incidence of pneumonia,anastomotic leakage,anastomotic stenosis,number of lymph node dissection and number of positive lymph nodes between the tubular stomach group and the whole stomach group(P>0.05).There was no significant difference in reflux symptom score and endoscopic esophageal mucosa between the two groups 6 months after operation or 6 months after stopping chemotherapy(P>0.05).The operation time of tubular stomach group was 27 minutes shorter than that of whole stomach group(P<0.001),bleeding was 11.1 ml less(P=0.015),exhaust time was 1.6 days earlier(P<0.001),hemoglobin was 8.8 g/L higher(P<0.001)and albumin was 4.1 g/L higher in tubular stomach group than that of whole stomach group 6 months after operation or 6 months after stopping chemotherapy(P=0.020).Conclusions The application of narrow tube gastroesophageal anastomosis in elderly patients with adenocarcinoma of the esophagogastric junction can shorten the operation time,reduce intraoperative bleeding,improve nutritional status,and do not increase the incidence of postoperative reflux esophagitis.It is a safe and feasible way of digestive tract reconstruction.