CAJ | 학술논문

目的探讨根治性近侧胃大部切除术后合理的消化道重建方法以及患者对术后辅助化疗的耐受性.方法回顾性分析30例食管残胃间空肠间置组(重建组)和30例食管残胃吻合组(对照组)胃癌患者的手术时间和术后并发症等.分析两组患者术后采用mFOLFOX-6方案辅助化疗的耐受性.结果重建组患者的手术时间为(162.2±14.0)min,对照组为(137.6±18.9) min,差异有统计学意义(P＜0.01).两组患者术后吻合口瘘、血液感染、导管相关感染、肺部感染情况比较,差异均无统计学意义(均P＞0.05).两组患者术后第2、4、6天的全身炎症反应综合征发生率和C反应蛋白水平比较,差异均无统计学意义(均P＞0.05).重建组患者术后第1、3、6个月胃食管反流病的症状评分均低于对照组,差异有统计学意义(均P＜0.05).重建组患者术后第1、3、6个月体重变化评分均低于对照组,差异有统计学意义(均P ＜0.05).共43例患者接受辅助化疗,其中重建组19例,18例顺利完成≥6个周期辅助化疗,1例完成5个周期化疗；对照组24例,12例顺利完成≥6个周期辅助化疗,12例完成＜6个周期化疗.两组患者的化疗完成率差异有统计学意义(P＜0.05).结论空肠间置术手术时间相对延长,术后并发症并未增加,术后烧心反流症状减轻,生活质量明显改善,体重及营养恢复较快,化疗耐受性好,是近端胃癌根治术后较合理的消化道重建方法.
목적 탐토근치성근측위대부절제술후합리적소화도중건방법이급환자대술후보조화료적내수성.방법 회고성분석30례식관잔위간공장간치조(중건조)화30례식관잔위문합조(대조조)위암환자적수술시간화술후병발증등.분석량조환자술후채용mFOLFOX-6방안보조화료적내수성.결과 중건조환자적수술시간위(162.2±14.0)min,대조조위(137.6±18.9) min,차이유통계학의의(P＜0.01).량조환자술후문합구루、혈액감염、도관상관감염、폐부감염정황비교,차이균무통계학의의(균P＞0.05).량조환자술후제2、4、6천적전신염증반응종합정발생솔화C반응단백수평비교,차이균무통계학의의(균P＞0.05).중건조환자술후제1、3、6개월위식관반류병적증상평분균저우대조조,차이유통계학의의(균P＜0.05).중건조환자술후제1、3、6개월체중변화평분균저우대조조,차이유통계학의의(균P ＜0.05).공43례환자접수보조화료,기중중건조19례,18례순리완성≥6개주기보조화료,1례완성5개주기화료；대조조24례,12례순리완성≥6개주기보조화료,12례완성＜6개주기화료.량조환자적화료완성솔차이유통계학의의(P＜0.05).결론 공장간치술수술시간상대연장,술후병발증병미증가,술후소심반류증상감경,생활질량명현개선,체중급영양회복교쾌,화료내수성호,시근단위암근치술후교합리적소화도중건방법.
Objective To explore an ideal method of digestive tract reconstruction and tolerance to adjuvant chemotherapy after radical proximal gastrectomy.Methods Thirty patients in the reconstruction group were treated by jejunal interposition,and other 30 patients received gastroesophagostomy (control group).The operation time,operation risk,occurrence of reflux esophagitis and postoperative 1-,3-,6-month nutrition statuses were evaluated.Forty-three patients received postoperative adjuvant chemotherapy with mFOLFOX-6 and tolerance to the chemotherapy was assessed.Results The operation time of the reconstructional group was (162.2 ± 14.0) min and that of the control group was (137.6 ± 18.9) mi,with a statistically significant difference.(t =-5.7,P ＜ 0.01).There were no significant differences of operation risk,postoperative 2-,4-,and 6-day C-reactive protein,2-,4-and 6-day systemic inflammatory response syndrome between the two groups.The differences of the occurrence of postoperative 1-,3-and 6-month reflux esophagitis and 3-and 6-month nutritional status between the two groups were statistically significant.18 of 19 (94.7％) patients in the reconstruction group completed all six cycles of chemotherapy,24 patients in the control group received chemotherapy,and 12 (50.0％) of them completed 6 cycles of chemotherapy.There was a significant difference in the completion rate of chemotherapy of the two groups (P ＜ 0.05).Conclusions The postoperative complications of jejunal interposition are not inceased,the symptoms of reflux esophagitis are alleviated,the quality of life can be improved,and there is a better tolerance to adjuvant chemotherapy.Therefore,jejunal interposition after radical proximal gastrectomy is a rational method of digestive tract reconstruction.