全胃切除术、近端胃大部切除术治疗贲门癌的效果及对近期预后的影响

Effects of Total gastrectomy and Proximal Subtotal Gastrectomy on Cardia Cancer and Its Influence on Short-term Prognosis

目的:对比全胃切除术、近端胃大部切除术治疗贲门癌的效果及对近期预后的影响。方法:将2015年2月~2018年2月纳入某院的80例贲门癌患者使用随机数字表法分为研究组和对照组各40例,对照组实行近端胃大部切除术,研究组实行全胃切除术。分析两组患者手术相关情况(手术时间、手术出血量、术后住院时间)及1年内复发率、生存率、并发症发生率差异,比较手术前和术后次日清晨血清应激反应指标[皮质醇(Cor)、C反应蛋白(CRP)]变化,比较手术前和手术半年后两组患者血清肿瘤标志物[血清癌胚抗原(CEA)、糖类抗原72-4(CA72-4)、糖类抗原-199(CA-199)]变化。结果:实施手术半年治疗后,两组患者的CEA、CA72-4、CA-199水平均较治疗前降低,且研究组水平低于对照组(P<0.05);研究组手术时间、术中出血量、术后住院时间、Cor和CRP水平均高于对照组(P<0.05);研究组1年内复发率、术后并发症发生率均低于对照组(P>0.05)。结论:全胃切除术相较近端胃大部切除术治疗贲门癌疗效更佳,对患者近期预后有利,但手术造成的应激反应略高,建议患者根据自身实际情况选择最佳术式。

Objective:To compare the effects of total gastrectomy and proximal subtotal gastrectomy on cardia cancer and its influence on short-term prognosis.Methods:Eighty patients with cardia cancer who were enrolled in a hospital from February 2015 to February 2018 were divided into study group and control group according to the random number table method,with 40 cases in each group.Control group underwent proximal subtotal gastrectomy while study group underwent total gastrectomy.The surgical related conditions(surgical time,surgical bleeding volume,postoperative hospital stay)and recurrence rate,survival rate and incidence rate of complications within 1 year were analyzed in the two groups.The serum stress response indicators[cortisol(Cor),C-reactive protein(CRP)]were compared before surgery and in the next morning after surgery.The serum tumor markers[serum carcinoembryonic antigen(CEA),carbohydrate antigen 72-4(CA72-4),carbohydrate antigen-199(CA-199)]were compared between the two groups before surgery and after 6 months of surgery.Results:After 6 months of surgery,the levels of CEA,CA72-4 and CA-199 in the two groups were lower than those before treatment,and the levels in study group were lower than those in control group(P<0.05).The surgical time and intraoperative blood loss,postoperative hospital stay and levels of Cor and CRP in study group were higher than those in control group(P<0.05).The recurrence rate within 1 year and incidence rate of postoperative complications in study group were lower than those in control group(P>0.05).Conclusion:Total gastrectomy has better efficacy than proximal subtotal gastrectomy on cardia cancer,which is beneficial to the short-term prognosis of patients,but it has slightly higher stress response caused by surgery.It is recommended that patients choose the best procedure according to their actual conditions.