摘要
目的:探讨近端胃大部切除间置空肠双通道吻合术和全胃切除食管空肠Roux-en-Y吻合术治疗贲门胃底癌的近远期效果。方法:回顾性分析74例贲门胃底癌患者的临床资料,根据手术方式的不同,分为全胃切除食管空肠Roux-en-Y吻合组(n=40,A组)和近端胃大部切除间置空肠双通道吻合组(n=34,B组)。统计两组围手术期基本指标、术后生活质量和防反流效果,随访3年后比较两组生存率情况。结果:两组手术出血量、术后排气时间及手术并发症率方面比较,差异无统计学意义(P>0.05);B组手术时间长于A组,差异有统计学意义(P<0.05);远期并发症方面:B组反流性食管炎、营养不良发生率显著低于A组,术后6个月Visick分级明显优于A组,差异均具有统计学意义(P<0.05);两组术后6个月、1年、3年生存率比较,差异均无统计学意义(P>0.05)。结论:近端胃大部切除间置空肠双通道吻合术治疗贲门胃底癌能取得同全胃切除食管空肠Roux-en-Y吻合术相接近的近远期手术效果,且在减少反流性食管炎等并发症、提高患者术后生活质量方面优势显著,值得临床推广应用。
Objective:To explore the short-term and long-term effects of proximal subtotal gastrectomy with double-channel jejunostomy and total gastrectomy with esophagojejunal Roux-en-Y anastomosis in the treatment of cardiac and gastric fundus cancer.Methods:The clinical data of 74 patients with cardiac and gastric fundus cancer were retrospectively analyzed.According to the different surgical methods,the patients were divided into Roux-en-Y anastomosis group after total gastrectomy(n=40,recorded as group A) and proximal subtotal gastrectomy with double-channel jejunostomy group(n=34,recorded as group B).The basic perioperative indicators,quality of life and anti-reflux effect were analyzed.The survival rates of the two groups were compared after 3 years of follow-up.Results:There was no significant difference in bleeding volume,exhaust time and complication rate between group A and group B(P>0.05).The operation time in group B was significantly longer than that in group A(P<0.05).In terms of long-term complications,the incidence of reflux esophagitis and malnutrition in group B was significantly lower than that in group A,and the Visick classification in group B was significantly better than that in group A at 6 months postoperatively,the differences were statistically significant(P<0.05).There was no significant difference in the survival rates of 6 months,1 year and 3 years after operation between the two groups(P>0.05).Conclusion:Proximal subtotal gastrectomy with interposition of jejunum double-channel anastomosis can achieve similar short-term and long-term results as total gastrectomy with esophagojejunal Roux-en-Y anastomosis.It has significant advantages in reducing complications such as reflux esophagitis and improving the quality of life of patients.It is worthy of clinical application.
作者
张永宏
陆王锋
任博博
李占盈
ZHANG Yong-hong;LU Wang-feng;REN Bo-bo;LI Zhan-ying(Department of Gastrointestinal Surgery,Central Hospital of Shangluo,Shangluo 726000,Shaanxi,China)
出处
《川北医学院学报》
CAS
2019年第1期110-113,共4页
Journal of North Sichuan Medical College
