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目的:探讨不同近端胃癌根治性切除术及重建术式的临床效果与术后生存情况。方法:分析2006年1月—2011年10月82例行近端胃癌根治切除术患者资料,其中22例行近端胃切除术后食管残胃吻合重建(食管胃吻合组),40例行全胃切除术后Roux-en-Y食管空肠吻合重建(食管空肠Roux-en-Y吻合组),20例行近端胃切除术后功能性空肠间置重建(空肠间置组),比较三组患者手术指标、术后并发症、营养状态以及术后生存率。结果:食管胃吻合组手术时间、出血量均明显少于另两组(均P<0.05);食管空肠Roux-en-Y吻合组淋巴结清扫数明显多于另两组,但营养指标方面不如另两组(均P<0.05);三组并发症总发生率均无统计学差异(P>0.05),但食管空肠Roux-en-Y吻合组腹泻、倾倒综合征发生率明显高于另两组(均P<0.05);三组患者1、3年生存率差异均无统计学意义(χ2=0.891,P=0.554;χ2=0.419,P=0.831)。结论:三种近端胃癌手术生存率相似,近端胃切除术加食管残胃吻合创伤性小,近端胃切除术加功能性空肠间置术后生活质量更高,临床应根据患者实际情况选择方案。
Objective: To investigate the clinical effect and postoperative survival of radical resection and reconstruction of proximal gastric cancer. Methods: From January 2006 to October 2011, 82 patients underwent radical resection of proximal gastric cancer were analyzed. Among them, 22 patients underwent esophageal stump reconstruction after esophageal resection (esophagogastric anastomosis) and 40 patients underwent total esophagectomy Roux-en-Y esophagojejunostomy (esophageal and jejunal Roux-en-Y anastomosis group) was performed after gastrectomy, and functional jejunal interstitial reconstruction (jejunal interposition group) was performed in 20 cases after gastrectomy. Three groups Patient’s operation indexes, postoperative complications, nutritional status and postoperative survival rate. Results: The operation time and bleeding volume of esophagogastric anastomosis group were significantly less than those of the other two groups (all P <0.05). The numbers of lymphadenectomy in Roux-en-Y anastomosis group were significantly more than those in the other two groups, but the nutritional indexes were not as good as those of the other two groups The incidence of diarrhea and dumping syndrome in Roux-en-Y anastomosis group was significantly higher than that in the other two groups (all P <0.05). There was no significant difference in the incidence of complications among the three groups (P> 0.05) (All P <0.05). There was no significant difference in the one and three year survival rates between the three groups (χ2 = 0.891, P = 0.554; χ2 = 0.419, P = 0.831). Conclusion: The survival rates of three kinds of proximal gastric cancer are similar. The results of proximal gastrectomy combined with traumatic esophagogastrostomy are small and the quality of life after proximal gastrectomy plus functional jejunal interposition is higher. According to the actual situation of the patients Options.