腹腔镜下全胃切除和近端胃切除治疗食管胃结合部腺癌的临床疗效对比

Comparison of clinical efficacy between laparoscopic total gastrectomy and proximal gastrectomy in the treatment of adenocarcinoma of esophagogastric junction

目的比较腹腔镜下行全胃切除(TG)和近端胃切除(PG)根治食管胃结合部腺癌的临床疗效及两种不同切除范围的优劣势。方法回顾性分析2020年1月到2021年12月由淮安市第一人民医院收治的90例食管胃结合部腺癌患者的临床诊治资料,并按照手术切除范围对其进行分组,其中PG组43例,TG组47例。比较两组患者的一般资料、手术相关指标等。结果TG组手术时间长于PG组,术中出血量、术中淋巴结清扫数量多于PG组,差异有统计学意义(P<0.05);两组术后3 d腹腔引流管引流量、术后拔除引流管时间、住院时间差异无统计学意义(P>0.05)。两组术后发症发生率差异无统计学意义(P>0.05)。术后TG组患者的血红蛋白、血清白蛋白、血清前白蛋白水平低于PG组,差异有统计学意义(P<0.05)。PG组和TG组的1年总生存率分别为95.3%和87.2%,差异无统计学意义(P>0.05)。结论与TG相比,PG更有利于患者术后营养物质的吸收和营养状态的恢复,临床应采取优化的重建方法来减少患者的反流。

Objective To compare the advantages and disadvantages of two different resection margins by observing the clinical efficacy of laparoscopic total gastrectomy(TG)and proximal gastrectomy(PG)for radical resection of adenocarcinoma of esophagogastric junction(AEJ).Methods A total of 90 patients with AEJ who were treated by Huai an No.1 People s Hospital from January 2020 to December 2021 were retrospectively reviewed.Patients were divided into PG group(n=43)and TG group(n=47)according to the surgical resection range.The general data,surgery related statistical indicators of the two groups were compared.Results The TG group had a longer operation time than the PG group,with significantly more intraoperative blood loss and a greater number of intraoperatively cleared lymph nodes than the PG group(P<0.05).There was no significant difference in terms of drainage volume of the abdominal drainage tubes in the 3-day postoperative period,postoperative period to the drainage removal,the length of hospitalization,and postoperative complications between two groups(P>0.05).Postoperative levels of hemoglobin,albumin,and prealbumin were significant lower in TG group compared with those in PG group(P<0.05).The 1-year overall survival rates for the PG group and TG group were 95.3%and 87.2%,respectively,and the difference was not statistically significant(P>0.05).Conclusion Compared with TG,PG is more conducive to the absorption of nutrients and the recovery of nutritional status after surgery,and it is also important to take optimal reconstruction methods to reduce reflux in patients.