两种不同术式治疗SiewertⅡ型食管胃结合部腺癌的疗效观察

Efficacy observation of two different surgical methods in the treatment of Siewert type Ⅱ adenocarcinoma of esophagogastric junction

目的探讨腹腔镜辅助近端胃切除术与开腹全胃切除术治疗SiewertⅡ型食管胃结合部腺癌的临床效果。方法117例SiewertⅡ型食管胃结合部腺癌患者,依据手术方式不同分为观察组(60例)和对照组(57例)。观察组实施腹腔镜辅助近端胃切除术治疗,对照组实施开腹全胃切除术治疗。比较两组患者手术相关指标、淋巴结清扫数目及术后并发症发生情况。结果观察组手术时间(175.33±17.22)min、术后排气时间(1.36±0.87)d、住院时间(10.14±1.14)d均短于对照组的(210.36±34.52)min、(2.36±1.18)d、(14.52±3.64)d,术中出血量(120.11±13.66)ml少于对照组的(347.22±28.74)ml,差异有统计学意义(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。观察组淋巴结清扫数目为(20.14±3.41)枚,对照组淋巴结清扫数目为(18.88±3.56)枚;两组淋巴结清扫数目比较,差异无统计学意义(P>0.05)。结论腹腔镜辅助近端胃切除术与开腹全胃切除术治疗SiewertⅡ型食管胃结合部腺癌淋巴结清扫数目及术后并发症相当,但腹腔镜辅助近端胃切除术可缩短手术时间、住院时间,减少术中出血量,患者术后排气时间早,值得推广。

Objective To discuss the clinical effect of laparoscopic-assisted proximal gastrectomy versus open total gastrectomy in the treatment of Siewert type Ⅱ adenocarcinoma of esophagogastric junction.Methods A total of 117 patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction were divided into observation group(60 cases)and control group(57 cases)according to different surgical methods.The observation group was treated with laparoscopic-assisted proximal gastrectomy,and the control group was treated with open total gastrectomy.The surgery-related indicators,number of lymph node dissections and postoperative complications were compared between the two groups.Results The operation time(175.33±17.22)min,postoperative exhaust time(1.36±0.87)d,and hospitalization time(10.14±1.14)d in the observation group were all shorter than(210.36±34.52)min,(2.36±1.18)d,(14.52±3.64)d in the control group,and the intraoperative blood loss(120.11±13.66)ml was less than(347.22±28.74)ml in the control group.All the differences were statistically significant(P<0.05).There was no statistically significant difference in postoperative complication rates between the two groups(P>0.05).The number of lymph node dissections in the observation group was(20.14±3.41)nodes,and the number of lymph node dissections in the control group was(18.88±3.56)nodes;the difference in the number of lymph node dissections between the two groups was not statistically significant(P>0.05).Conclusion Laparoscopic-assisted proximal gastrectomy is comparable to open total gastrectomy for Siewert type Ⅱ adenocarcinoma of esophagogastric junction in terms of number of lymph node dissection and postoperative complications,but laparoscopic-assisted proximal gastrectomy can shorten operation time and hospitalization time,reduce intraoperative blood loss,and shorten postoperative exhaust time of patients,which is worth promoting.