中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2012年
3期
207-210
,共4页
朱纯超%赵刚%徐佳%赵恩昊%曹晖
硃純超%趙剛%徐佳%趙恩昊%曹暉
주순초%조강%서가%조은호%조휘
食管胃结合部腺癌%SiewertⅠ型%手术径路%预后因素
食管胃結閤部腺癌%SiewertⅠ型%手術徑路%預後因素
식관위결합부선암%SiewertⅠ형%수술경로%예후인소
Adenocarcinoma of the esophagngastric junction%Siewert type Ⅰ%Surgical approach%Prognostic factors
目的 探讨Siewert Ⅰ型食管胃结合部腺癌(AEG)合珲的手术径路及影响患者预后的因素.方法 回顾性分析2005年1月至2009年12月七海交通大学医学院附属仁济医院收治的103例Siewert Ⅰ型AEG患者的临床资料.根据手术径路将患者分为2组:单纯经胸手术组(61例),胸腹联合手术组(42例).两组患者术中腹腔淋巴结清扫和术后并发症情况比较分别采用x2检验(例数＜1时采用Fisher确切概率法)及t检验.Kaplan-Meier法绘制生存曲线,Log-rank检验分析生存情况.患者预后分析采用单因素方差分析,多因素分析采用COX回归模型.结果 两组患者均无围手术期死亡.单纯经胸手术组和胸腹联合手术组患者在腹腔淋巴结清扫和转移数目两方面比较,差异有统计学意义(t=2.18,2.29,P＜0.05)；术中脾脏损伤比较,差异无统计学意义(P＞0.05)；术后出血、吻合口瘘、吻合口狭窄、胃食管反流、肺部感染、切口处骨髓炎等并发症发生率方面比较,差异无统计学意义(X2=0.07,0.94,0.22,1.41,0.17,P＞0.05).全组患者随访率为94.2％ (97/103),术后中位生存时间为26个月,术后3年生存率为35.9％.单纯经胸手术组和胸腹联合手术组患者术后3年生存率分别为32.8％和40.2％,两组比较,差异无统计学意义(x2=0.37,P ＞0.05).单因素分析结果表明,患者的3年生存率与手术方式、TNM分期、N分期、肿瘤直径、淋巴结转移率、根治程度有关(x2 =21.07,26.04,22.42,6.26,32.20,20.80,P＜0.05).多因素分析结果表明,TNM分期、淋巴结转移率及根治程度是影响患者预后的独立危险因素(Wald=12.01,8.75,10.03,P＜0.05).结论 胸腹联合入路是Siewert Ⅰ型AEG患者更为合理的手术径路选择.TNM分期、淋巴结转移率、根治程度是影响患者预后的独立危险因素.
目的 探討Siewert Ⅰ型食管胃結閤部腺癌(AEG)閤琿的手術徑路及影響患者預後的因素.方法 迴顧性分析2005年1月至2009年12月七海交通大學醫學院附屬仁濟醫院收治的103例Siewert Ⅰ型AEG患者的臨床資料.根據手術徑路將患者分為2組:單純經胸手術組(61例),胸腹聯閤手術組(42例).兩組患者術中腹腔淋巴結清掃和術後併髮癥情況比較分彆採用x2檢驗(例數＜1時採用Fisher確切概率法)及t檢驗.Kaplan-Meier法繪製生存麯線,Log-rank檢驗分析生存情況.患者預後分析採用單因素方差分析,多因素分析採用COX迴歸模型.結果 兩組患者均無圍手術期死亡.單純經胸手術組和胸腹聯閤手術組患者在腹腔淋巴結清掃和轉移數目兩方麵比較,差異有統計學意義(t=2.18,2.29,P＜0.05)；術中脾髒損傷比較,差異無統計學意義(P＞0.05)；術後齣血、吻閤口瘺、吻閤口狹窄、胃食管反流、肺部感染、切口處骨髓炎等併髮癥髮生率方麵比較,差異無統計學意義(X2=0.07,0.94,0.22,1.41,0.17,P＞0.05).全組患者隨訪率為94.2％ (97/103),術後中位生存時間為26箇月,術後3年生存率為35.9％.單純經胸手術組和胸腹聯閤手術組患者術後3年生存率分彆為32.8％和40.2％,兩組比較,差異無統計學意義(x2=0.37,P ＞0.05).單因素分析結果錶明,患者的3年生存率與手術方式、TNM分期、N分期、腫瘤直徑、淋巴結轉移率、根治程度有關(x2 =21.07,26.04,22.42,6.26,32.20,20.80,P＜0.05).多因素分析結果錶明,TNM分期、淋巴結轉移率及根治程度是影響患者預後的獨立危險因素(Wald=12.01,8.75,10.03,P＜0.05).結論 胸腹聯閤入路是Siewert Ⅰ型AEG患者更為閤理的手術徑路選擇.TNM分期、淋巴結轉移率、根治程度是影響患者預後的獨立危險因素.
목적 탐토Siewert Ⅰ형식관위결합부선암(AEG)합혼적수술경로급영향환자예후적인소.방법 회고성분석2005년1월지2009년12월칠해교통대학의학원부속인제의원수치적103례Siewert Ⅰ형AEG환자적림상자료.근거수술경로장환자분위2조:단순경흉수술조(61례),흉복연합수술조(42례).량조환자술중복강림파결청소화술후병발증정황비교분별채용x2검험(례수＜1시채용Fisher학절개솔법)급t검험.Kaplan-Meier법회제생존곡선,Log-rank검험분석생존정황.환자예후분석채용단인소방차분석,다인소분석채용COX회귀모형.결과 량조환자균무위수술기사망.단순경흉수술조화흉복연합수술조환자재복강림파결청소화전이수목량방면비교,차이유통계학의의(t=2.18,2.29,P＜0.05)；술중비장손상비교,차이무통계학의의(P＞0.05)；술후출혈、문합구루、문합구협착、위식관반류、폐부감염、절구처골수염등병발증발생솔방면비교,차이무통계학의의(X2=0.07,0.94,0.22,1.41,0.17,P＞0.05).전조환자수방솔위94.2％ (97/103),술후중위생존시간위26개월,술후3년생존솔위35.9％.단순경흉수술조화흉복연합수술조환자술후3년생존솔분별위32.8％화40.2％,량조비교,차이무통계학의의(x2=0.37,P ＞0.05).단인소분석결과표명,환자적3년생존솔여수술방식、TNM분기、N분기、종류직경、림파결전이솔、근치정도유관(x2 =21.07,26.04,22.42,6.26,32.20,20.80,P＜0.05).다인소분석결과표명,TNM분기、림파결전이솔급근치정도시영향환자예후적독립위험인소(Wald=12.01,8.75,10.03,P＜0.05).결론 흉복연합입로시Siewert Ⅰ형AEG환자경위합리적수술경로선택.TNM분기、림파결전이솔、근치정도시영향환자예후적독립위험인소.
Objective To investigate rational surgical approaches for Siewert type Ⅰ adenocarcinoma of the esophagogastric junction (AEG),and analyze the prognostic factors.Methods The clinical data of 103 patients with Siewert type Ⅰ AEG who were admitted to the Renji Hospital from January 2005 to December 2009 were retrospectively analyzed.All patients were divided into transthoracic approach group (61 patients) and thoracoabdominal approach group (42 patients).The incidences of numbers of lymph node dissected and postoperative complications of the 2 groups were compared using the chi-square test,Fisher exact probability or the t test.The survival curve was drawn by the Kaplan-Meier method and the survival was analyzed using the Log-rank test.Prognostic factors were analyzed using the one-way analysis of variance and Cox regression model.Results No perioperative death was observed in the 2 groups.There were significant differences in the number of lymph node dissected and number of metastatic lymph node between the 2 groups (t =2.18,2.29,P ＜ 0.05 ).There was no significant difference in splenic injury between the 2 groups (P ＞ 0.05 ).There were no significant differences in postoperative bleeding,anastomotic fistula and stricture,esophagogastric reflux,pulmonary infection and esteomyelitis between the 2 groups (x2 =0.07,0.94,0.22,1.41,0.17,P＞0.05).Of the 103 patients,97(94.2％) were followed up.The mean postoperative survival time was 26 months.The median survival time was 26 months,and the 3-yearsurvival rate was 35.9％.The 3-year survival rates of transthoracic approach group and thoracoabdominal approach group were 32.8％ and 40.2％,with no significant difference between the 2 groups ( x2 =0.37,P ＞ 0.05).The results of univariate analysis showed that radical or palliative resection,TNM stage,lymph node metastasis stage,tumor diameter and metastasis rate,degree of radical resection were independent factors influencing the prognosis of patients with Siewert type Ⅰ AEG (x2 =21.07,26.04,22.42,6.26,32.20,20.80,P＜0.05).The results of multivariate analysis showed that degree of TNM stage,lymph node metastasis rate and radical resection were independent factors influencing the prognosis of patients ( Wald =12.01,8.75,10.03,P ＜ 0.05 ).Conclusions Thoracoabdominal approach is a reasonable selection for patients with Siewert type I AEG.Degree of TNM stage,lymph node metastasis rate and radical resection were independent risk factors influencing the prognosis of patients.
