摘要
目的观察胃近端根治术保留远端残胃联合食管-空肠与残胃-空肠双通道吻合术治疗胃上部癌的效果。方法选取41例接受胃近端根治术联合食管-空肠与残胃-空肠双通道吻合术治疗的胃上部癌患者(双通道组)和41例接受常规胃全切术联合食管-空肠Roux-en-Y吻合术治疗的胃上部癌患者(常规组)。观察两组患者的手术治疗指标(手术时间、术中出血量、术后首次排气时间、术后住院时间)、术后并发症(倾倒综合征、反流性食管炎、术后出血、术后梗阻、吻合口瘘/狭窄、残胃无张力)的发生情况、术后1年营养状态(血浆总蛋白、血浆白蛋白、血红蛋白及减轻体重)及生活质量、术后3年的生存情况。结果双通道组患者的手术时间明显长于常规组,术中出血量明显少于常规组,术后首次排气时间、术后住院时间均明显短于常规组,差异均有统计学意义(P﹤0.01)。双通道组患者术后倾倒综合征、反流性食管炎的发生率均低于常规组,差异均有统计学意义(P﹤0.05)。术后1年,双通道组患者的血浆总蛋白、血浆白蛋白、血红蛋白及SF-36生活质量量表各维度评分均高于常规组,体重减轻低于常规组,差异均有统计学意义(P﹤0.05)。术后3年,双通道组患者的生存率为97.6%,高于常规组的85.4%,差异有统计学意义(χ2=3.977,P=0.046)。结论保留远端残胃联合双通道吻合术治疗胃上部癌患者,疗效满意,术后并发症的发生率低,可有效地改善患者术后营养状态和生活质量,提高远期生存率,有临床应用价值。
Objective To observe the curative effect of proximal gastrectomy with double tract anastomosis ofesoph- agojejunal anastomosis or gastrojejunostomy in the treatment of upper gastric cancer. Method 41 cases of upper gastric cancer patients who were given proximal gastrectomy combined with esophagojejunal anastomosis or gastrojejunostomy as double tract anastomosis （double tract anastomosis group） and another 41 cases who were administered with conven- tional radical gastrectomy combined with esophagojejunostomy Roux-en-Y anastomosis were included as control （con- ventional therapy group）. The surgery related measures （operative time, intraoperative blood loss, postoperative exhaust time, postoperative hospital stay）, postoperative complications （dumping syndrome, reflux esophagitis, postoperative bleeding, postoperative obstruction, anastomosis fistula/stricture, gastroparesis）, nutritional status 1 year after surgery （to- tal plasma protein, plasma albumin, hemoglobin and weight loss） and quality of life, postoperative survival in 3 years af- ter surgery were observed. Result The operative time of the double tract anastomosis group was longer than that of the conventional therapy group, and the intraoperative blood loss, postoperative exhaust time and hospital stay were less than those of the conventional therapy group, showing statistically significant difference （P〈0.01）. The incidence of dumping syndrome and reflux esophagitis were lower in double tract anastomosis group than that of conventional therapy group, with statistically significant difference observed （P〈0.05）. In 1 year after surgery, the total plasma protein, plasma albu- min, and hemoglobin, as well as SF-36 score were better in double tract anastomosis group than in conventional therapy group, and the weight loss was less than that in those who received conventional therapy （P〈0.05）; in 3 years after sur- gery, the survival rate in the double tract anastomosis group was 97.6%, which was higher than the 85.4%
作者
蒙锦莹
王擎石
陈宏宏
王华
施大为
刘永存
马宁
MENG Jinying;WANG Qingshi;CHEN Honghong;WANG Hua;SHI Dawei;LIU Yongcun;MA Ning(Department of Surgical Oncology,the First People＇s Hospital of Xianyang,Xianyang 712000,Shaanxi,China)
出处
《癌症进展》
2018年第8期973-976,共4页
Oncology Progress
关键词
胃上部癌
双道吻合
胃近端根治术
upper gastric cancer
double tract anastomosis
proximal gastrectomy
