摘要
目的研究胃切除术对食管癌临床特征及手术效果的影响。方法收集1997年6月至2007年6月在南京大学医学院附属鼓楼医院接受食管癌根治手术的患者1376例,其中48例有胃切除史作为残胃组,其余1328例无胃切除史作为非残胃组,比较两组间食管癌临床病理学特征、根治手术效果、术后生存率的差异。结果与非残胃组比较残胃组食管癌多呈膨胀性生长,而无残胃组食管癌多表现为浸润生长;两组食管癌组织分型均以鳞癌为主(91.7%vs 92.2%);残胃组食管癌与非残胃组食管癌组相比,分布位置表现为多发性的比例较大(14.6%vs 5.3%,P=0.006),且残胃组食管癌更易发生于食管下段(50.0%vs 33.1%,P=0.03)残胃组食管癌病理分期较非残胃组早,Ⅰ、Ⅱ期多于Ⅲ、Ⅳ期(P=0.008),但肿瘤分期和淋巴结的阳性数组间比较差异无统计学意义。有胃切除史患者的手术时间较无胃切除史的患者长[(311.2±86.0)min vs(363±84.9)min]且术中失血较多[(876±213)m L vs(3750±380)m L]、中位住院时间较长(69 d vs 40 d,P<0.01),两组术后并发症情况差异无统计学意义(P>0.05)。两组术后60个月生存率比较,差异无统计学意义(P>0.05)。结论患者接受胃切除术后易发生慢性胃食管反流,可引起鳞状上皮不典型增生和位于食管下段的多发性、膨胀性癌灶。有胃切除史患者的食管癌手术后生存率与无胃切除史的患者相似,因此对于接受胃切除术的患者,食管癌根治术是安全且有效的。
Objective To investigate the influence of gastrectomy on the clinicopathological characteristics and surgical outcome of thoracic esophageal cancer. Methods Data of 1376 consecutive patients with primary thoracic esophageal cancer who underwent curative operation from Jun. 1997 to Jun. 2007 was collected. 48 patients received gastrectomy as the remnant stomach group and the rest of 1328 patients without a history of gastrectomy as the non-remnant stomach group. The clinicopathological characteristics,surgicl outcome and postoperative survival of the two groups were compared. Results Compared with the non-remnant stomach group,most cases of the remnant group presented expansive growth,while most cases in non-remnant presented invasive growth; the major cancerous tissue type of both groups was squamous cell carcinoma（ 91. 7% vs 92. 2%）; the proportion of lower-third tumors of the remnant stomach group was significantly higher than that of the non-remnant stomach group（ 50. 0% vs 33. 1%,P = 0. 03） and so was proportion of the multiple esophageal cancer（ 14. 6% vs 5. 3%,P = 0. 006,respectively）. The esophageal cancer pathological stage of remnant stomach group was less advanced than the non-remnant stomach group,i. e. more cases of stage Ⅰ,Ⅱ than Ⅲ,Ⅳ（ P= 0. 008）,while there was no statistically significant difference in tumor stage and positive lymph node number.The operative time of the patients with gastrectomy was longer than the patients without gastrectomy[（ 311. 2 ±86. 0） vs（ 363 ± 84. 9） min]and blood loss was more[（ 876 ± 213） m L vs（ 3750 ± 380） m L],the median postoperative hospital stay was significantly longer（ 69 d vs 40 d,P〈0. 01）. There was no significant difference in postoperative complications between the two groups（ P〉0. 05）. The overall 60-month survival of gastrectomized and non-gastrectomized patients were similar（ P〉0. 05）. Conclusion The patients with gastrectomy are more prone to subsequent chronic gastroesophageal reflux and may i
出处
《医学综述》
2014年第22期4216-4218,共3页
Medical Recapitulate
关键词
胃切除术
食管癌
手术效果
生存率
Gastrectomy
Esophageal cancer
Surgical outcome
Survival rate
