近端胃癌根治术不同切除及重建方案的短期及长期效果

Short-term and Long-term Efficacy of Different Tumor Resection and Reconstruction Scheme in Proximal Gastric Cancer

目的探讨近端胃癌根治术不同手术方式及重建方式对患者长短期预后的影响。方法将120例近端胃癌患者随机分为PG-EG、TG-RY、PG-JI 3组,3组患者的手术方式及重建方式不同。观察3组患者的围手术期以及近远期并发症对患者的影响。结果 3组患者在手术时间、术中出血量以及淋巴结清扫个数上的差异具有统计学意义(P<0.05),且TG-RY组的手术时间、术中出血量以及淋巴结清扫个数上明显比其余2组多。但是3组在术后感染率、吻合口瘘发生率以及肠梗阻的发生上差异不具有统计学意义(P>0.05)。3组相比较,远期并发症如倾倒综合征以及碱性反流性胃炎存在明显差异,具有统计学意义(P<0.05),且TG-RY组这两种并发症的发生率比其余2组高。但是3组在随访中在肿瘤的复发率上差异不具有统计学意义(P>0.05)。3组患者在随访中发现,患者的无瘤生存率在1年(92.5%,95.0%,95.0%)、3年(57.5%,62.5%,60.0%)以及5年(19.0%,17.0%,20.0%)上没有明显差异,不具有统计学意义(P>0.05)。结论 PG-EG、TG-RY、PG-JI 3种手术及重建方式各有利弊,应根据患者的具体实际情况选择手术及重建方式以期达到最佳治疗效果。

Objective To study the effect of different tumor resection and reconstruction scheme in proximal gastric cancer on prognosis. Methods 120 patients diagnosed as proximal gastric cancer were randomly divided into PG-EG group,TGRY group,and PG-JI group. The 3 groups received different operation and reconstructions methods. Effect of perioperative,shortterm and long-term complications on patients were observed. Results There had statistically significant difference in the 3 groups in operative time,bleeding volume,and lymph node dissection number( P < 0. 05),and operative time,bleeding volume,and lymph node dissection number of TG-RY group were significantly higher than those of the other 2 groups. But the 3 groups had no statistically significant difference in infection,anastomotic leakage rate and intestinal obstruction occurrence rate( P > 0. 05). The long-term complications such as dumping syndrome and alkaline reflux gastritis had obvious difference in the 3 groups,( P <0. 05),and dumping syndrome and alkaline reflux gastritis of TG-RY group had higher incidence than those of the other 2 groups.There had no statistically significant difference in the 3 groups in tumor recurrence rate( P > 0. 05). There had no statistically significant difference in the 3 groups( P > 0. 05) in 1-year tumor free survival rates( 92. 5%,95. 0%,95. 0%),3-year tumor free survival rates( 57. 5%,62. 5%,60. 0%) and 5-year tumor free survival rates( 19. 0%,17. 0%,20. 0%). Conclusion PG-EG,TG-RY,PG-JI have advantages and disadvantages,actual situation of patients should be considered in selecting specific operation and reconstruction mode,in order to achieve the best therapeutic effect.