CAJ | 학술논문

目的：探讨早期食管胃结合部腺癌根治术后消化道重建的理想方式。方法河南科技大学第一附属医院胃肠肿瘤外科前瞻性入组2003年1月至2011年12月接受根治性切除术的Ⅱ型和Ⅲ型早期食管胃结合部腺癌患者153例。按照随机数字表法分为3S吻合组（80例，采用3S空肠间置法吻合）和传统吻合组（73例，采用食管残胃后壁吻合）。观察比较两组患者近、远期并发症发生率、营养指标及术后生活质量。结果3S吻合组与传统吻合组手术时间[（163．2±12．3） min比（154．7±14．1） min]及围手术期并发症发生率[7．5％（6/80）比13．7％（10/73）]的差异均无统计学意义（均P＞0．05）。从术后6月开始，3S吻合组的血清总蛋白、白蛋白、血红蛋白及维生素B12等营养指标均明显高于传统吻合组（均P＜0．05）。术后18月，3S吻合组较传统吻合组反流性食管炎发生率明显降低[20．0％（16/80）比46．6％（34/73）， P＜0．01]，胃排空时间明显延长[（160．8±8．1） min 比（61．1±10．8） min， P＜0．01]。术后QLQ-C30量表调查结果显示，3S吻合组术后生活质量明显高于传统吻合组（P＜0．05）。结论Ⅱ型和Ⅲ型早期食管胃结合部腺癌近端胃切除后采用3S空肠间置法进行消化道重建，具有良好的抗反流效果，可改善患者的远期营养状况和生活质量。
목적：탐토조기식관위결합부선암근치술후소화도중건적이상방식。방법하남과기대학제일부속의원위장종류외과전첨성입조2003년1월지2011년12월접수근치성절제술적Ⅱ형화Ⅲ형조기식관위결합부선암환자153례。안조수궤수자표법분위3S문합조（80례，채용3S공장간치법문합）화전통문합조（73례，채용식관잔위후벽문합）。관찰비교량조환자근、원기병발증발생솔、영양지표급술후생활질량。결과3S문합조여전통문합조수술시간[（163．2±12．3） min비（154．7±14．1） min]급위수술기병발증발생솔[7．5％（6/80）비13．7％（10/73）]적차이균무통계학의의（균P＞0．05）。종술후6월개시，3S문합조적혈청총단백、백단백、혈홍단백급유생소B12등영양지표균명현고우전통문합조（균P＜0．05）。술후18월，3S문합조교전통문합조반류성식관염발생솔명현강저[20．0％（16/80）비46．6％（34/73）， P＜0．01]，위배공시간명현연장[（160．8±8．1） min 비（61．1±10．8） min， P＜0．01]。술후QLQ-C30량표조사결과현시，3S문합조술후생활질량명현고우전통문합조（P＜0．05）。결론Ⅱ형화Ⅲ형조기식관위결합부선암근단위절제후채용3S공장간치법진행소화도중건，구유량호적항반류효과，가개선환자적원기영양상황화생활질량。
Objective To investigate the better method of digestive tract reconstruction in proximal gastrectomy for early gastroesophageal junction adenocarcinoma. Methods A total of 153 cases of early gastroesophageal junction adenocarcinoma who were planned to receive radical proximal gastrectomy from January 2003 to December 2011 were prospectively enrolled and randomly divided into two groups by table of random number according to methods of digestive tract reconstruction , including 3S anastomosis group (80 cases, 3S jejunal interposition) and traditional anastomosis group (73 cases, esophageal remnant gastric posterior wall anastomosis). Postoperative complications, operative time, mortality, nutritional parameters and postoperative quality of life were compared between these two groups. Results There were no significant differences between two groups in postoperative complications, operative time and mortality (all P>0.05). 3S anastomosis group was better in nutritional parameters than traditional group six months after operation (P<0.05). As compared to traditional group, incidence of reflux esophagitis decreased [20.0%(16/80) vs. 46.6%(34/73), P<0.01] and gastric emptying time prolonged obviously [(160.8 ±8.1) min vs. (61.1 ±10.8) min, P<0.01] in 3S anastomosis group 18 months after operation. Postoperative QLQ-C30 rating scale revealed quality of life was significantly higher in 3S anastomosis group as compared to traditional group. Conclusion Jejunal interposition is a better method of digestive tract reconstruction in proximal gastrectomy for early gastroesophageal junction carcinoma.