全胃切除與近端胃大部切除對SiewertⅡ型食管胃結合部腺癌患者近期預后影響的對照研究

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1.湖北省丹江口市第一人民醫院普外科，湖北 丹江口 442700； 2.華中科技大學同濟醫學院附屬協和醫院

【Abstract】ObjectiveTo investigate the effect of short-term prognosis of total gastrectomy and proximal subtotal gastrectomy for Siewert Ⅱesophagogastric junction (EGJ) adenocarcinomas.MethodsSixty-seven patients with EGJ adenocarcinomas were collected from Jan. 2012 to Jan. 2015, according to the different surgical methods, patients were divided into two groups: 31 cases in the control group underwent proximal subtotal gastrectomy, 36 cases in the observation group underwent total gastrectomy. The operation and postoperative situation were compared between two groups. After 24 months of follow-up, the survival rates were compared between two groups.ResultsThe operation time, the number of lymph node dissection, positive lymph node number, distal margin length in observation group were significantly higher than those in the control group, the R1resection rate was significantly lower in observation group than that in the control group (P<0.05). Feeding time, exhaust time, borborygmus recovery time and hospitalization time in the observation group were significantly lower than those in the control group (P<0.05); there was no significant difference in the incidence of postoperative complications between two groups (P>0.05); 12 months after the operation, the GERD-Q score in the observation group was significantly lower than that in the control group (P<0.05); after 24 months of follow-up, survival rate had no significant difference between two groups (P>0.05).ConclusionThe survival rate of total gastrectomy for the treatment of Siewert Ⅱ EGJ adenocarcinomas is similar to that of the proximal subtotal gastrectomy, but total gastrectomy can improve the effect of lymph node dissection, promote the early recovery of patients, and alleviate gastroesophageal reflux symptoms, it is worthy of clinical attention.

【Keywords】 Esophagogastric junction adenocarcinomas; Total gastrectomy; Proximal subtotal gastrectomy; Curative effect; Short-term prognosis

食管胃結合部(esophagogastric junction,EGJ)腺癌指的是腫瘤病灶位于EGJ近端及遠端5 cm以內的腫瘤，根據Siewert分型可將其分為Ⅰ型、Ⅱ型和Ⅲ型，Ⅱ型和Ⅲ型發病率較高。Ⅰ型EGJ腺癌以近端胃切除術聯合部分食管切除術治療為主；對于Ⅱ型和Ⅲ型EGJ腺癌，手術入路方式包括經腹和經胸入路，其中經腹入路以全胃切除術與近端胃大部切除術為主。不過目前臨床中對于選取何種術式治療爭議較大，全胃切除術可能會增加手術時間，延長患者術后恢復時間；而近端胃大部切除術則增加了患者術后營養不良及胃食管反流程度。本研究分析了全胃切除術與近端胃大部切除術治療SiewertⅡ型EGJ腺癌的手術效果，并分析了對患者近期預后的影響，旨在為臨床治療提供參考依據。現將結果報道如下。

1 資料與方法

1.1一般資料選取2012年1月至2015年1月湖北省丹江口市第一人民醫院收治的67例EGJ腺癌患者作為研究對象，術前均行鋇餐、B超、CT及胃鏡檢查，經胃鏡病理檢查確診。納入標準：(1)均為SiewertⅡ型EGJ腺癌；(2)無遠處轉移；(3)術前胃食管反流病問卷(GERD-Q)評分均在8分以下；(4)均無腦、腎臟、肝臟等重要器官功能障礙。排除標準：(1)合并其他胃腸病者；(2)術前行放化療者；(3)胃排空異常或食管下端壓力異常者；(4)存在凝血功能障礙者；(5)病例資料不全者；(6)易失訪者。本研究經醫院倫理委員會研究同意，并與患者及家屬簽署知情同意書。67例患者中，男39例，女28例，年齡(59.78±4.09)歲(46～77歲)。根……