中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2015年
5期
437-441
,共5页
赵群%李勇%杨沛刚%檀碧波%范立侨%焦志凯%赵雪峰%张志栋%王冬%刘羽%田园
趙群%李勇%楊沛剛%檀碧波%範立僑%焦誌凱%趙雪峰%張誌棟%王鼕%劉羽%田園
조군%리용%양패강%단벽파%범립교%초지개%조설봉%장지동%왕동%류우%전완
食管胃结合部腺癌%改良空肠间置术%食管反流%生活质量
食管胃結閤部腺癌%改良空腸間置術%食管反流%生活質量
식관위결합부선암%개량공장간치술%식관반류%생활질량
Adenocarcinoma of the esophagogastric junction%Modified double tracks anastomosis%Reflux%Quality of life
目的：探讨改良空肠间置术在SiewertⅡ型和Ⅲ型食管胃结合部腺癌（AEG）根治术中的应用效果。方法回顾性分析河北医科大学第四医院外三科2004年1月至2008年12月期间经开腹行根治术的763例SiewertⅡ型和Ⅲ型AEG患者的临床资料。其中行根治性近侧胃大部切除改良空肠间置术266例（空肠间置组）；根治性近侧胃大部切除食管残胃吻合术252例（食管残胃吻合组）；根治性全胃切除食管空肠Roux-en-Y吻合术245例（Roux-en-Y吻合组）。对3组患者的手术根治性、安全性、生活质量及预后进行比较。结果空肠间置组、食管残胃吻合组和Roux-en-Y吻合组术后并发症发生率分别为8．6％（23／266）、8．3％（21／252）和7．8％（19／245），3组间差异无统计学意义（P＞0．05）。空肠间置组术后6个月胃肠道症状GSRS评分、反流症状Visick分级和反流症状内镜Los Angeles（LA）分级优于食管残胃吻合组（均P＜0．05）；空肠间置组GSRS评分和术后6个月进食量恢复百分比值均优于Roux-en-Y吻合组（均P＜0．05）。术后3年空肠间置组和食管残胃吻合组残胃复发率分别为0．8％（2／244）和1．2％（3／224），差异无统计学意义（P＞0．05）。空肠间置组、食管残胃吻合组和Roux-en-Y吻合组5年总生存率分别为48．7％、46．3％和50．2％，差异无统计学意义（P＞0．05）。结论改良空肠间置术是SiewertⅡ型和Ⅲ型AEG根治术后较为理想的手术方式。
目的：探討改良空腸間置術在SiewertⅡ型和Ⅲ型食管胃結閤部腺癌（AEG）根治術中的應用效果。方法迴顧性分析河北醫科大學第四醫院外三科2004年1月至2008年12月期間經開腹行根治術的763例SiewertⅡ型和Ⅲ型AEG患者的臨床資料。其中行根治性近側胃大部切除改良空腸間置術266例（空腸間置組）；根治性近側胃大部切除食管殘胃吻閤術252例（食管殘胃吻閤組）；根治性全胃切除食管空腸Roux-en-Y吻閤術245例（Roux-en-Y吻閤組）。對3組患者的手術根治性、安全性、生活質量及預後進行比較。結果空腸間置組、食管殘胃吻閤組和Roux-en-Y吻閤組術後併髮癥髮生率分彆為8．6％（23／266）、8．3％（21／252）和7．8％（19／245），3組間差異無統計學意義（P＞0．05）。空腸間置組術後6箇月胃腸道癥狀GSRS評分、反流癥狀Visick分級和反流癥狀內鏡Los Angeles（LA）分級優于食管殘胃吻閤組（均P＜0．05）；空腸間置組GSRS評分和術後6箇月進食量恢複百分比值均優于Roux-en-Y吻閤組（均P＜0．05）。術後3年空腸間置組和食管殘胃吻閤組殘胃複髮率分彆為0．8％（2／244）和1．2％（3／224），差異無統計學意義（P＞0．05）。空腸間置組、食管殘胃吻閤組和Roux-en-Y吻閤組5年總生存率分彆為48．7％、46．3％和50．2％，差異無統計學意義（P＞0．05）。結論改良空腸間置術是SiewertⅡ型和Ⅲ型AEG根治術後較為理想的手術方式。
목적：탐토개량공장간치술재SiewertⅡ형화Ⅲ형식관위결합부선암（AEG）근치술중적응용효과。방법회고성분석하북의과대학제사의원외삼과2004년1월지2008년12월기간경개복행근치술적763례SiewertⅡ형화Ⅲ형AEG환자적림상자료。기중행근치성근측위대부절제개량공장간치술266례（공장간치조）；근치성근측위대부절제식관잔위문합술252례（식관잔위문합조）；근치성전위절제식관공장Roux-en-Y문합술245례（Roux-en-Y문합조）。대3조환자적수술근치성、안전성、생활질량급예후진행비교。결과공장간치조、식관잔위문합조화Roux-en-Y문합조술후병발증발생솔분별위8．6％（23／266）、8．3％（21／252）화7．8％（19／245），3조간차이무통계학의의（P＞0．05）。공장간치조술후6개월위장도증상GSRS평분、반류증상Visick분급화반류증상내경Los Angeles（LA）분급우우식관잔위문합조（균P＜0．05）；공장간치조GSRS평분화술후6개월진식량회복백분비치균우우Roux-en-Y문합조（균P＜0．05）。술후3년공장간치조화식관잔위문합조잔위복발솔분별위0．8％（2／244）화1．2％（3／224），차이무통계학의의（P＞0．05）。공장간치조、식관잔위문합조화Roux-en-Y문합조5년총생존솔분별위48．7％、46．3％화50．2％，차이무통계학의의（P＞0．05）。결론개량공장간치술시SiewertⅡ형화Ⅲ형AEG근치술후교위이상적수술방식。
Objective To discuss the effect of modified double tracks anastomosis in patients with type Siewert Ⅱ-Ⅲ adenocarcinoma of the esophagogastric junction (AEG) treated with radical gastrectomy. Methods Clinical data of 763 patients with type Siewert Ⅱ-Ⅲ AEG undergoing radical operation in our department from January 2004 to December 2008 were analyzed retrospectively. Patients were randomized into 3 groups according to the different procedures modes: radical proximal gastrectomy with modified double tracks anastomosis (266 cases), radical proximal gastrectomy with esophageal gastric stump end-to-side anastomosis (252 cases), and radical total gastrectomy with esophageal jejunum Roux-en-Y anastomosis(245 cases). There were no significant differences in general information and biological characteristics among the 3 groups (all P>0.05). Radical degree, safety, quality of life and prognosis were compared among 3 groups. Results There were no significant differences in postoperative complications among the three groups (P>0.05). Six months after operation, in modified double tracks anastomosis group, food intake recovery percentage was superior to the other two groups, and the Visick scores and endoscopic grading were better than esophageal gastric stump end-to-side anastomosis group (all P<0.05). There was no significant difference in recurrent rate of gastric stump between modified double tracks anastomosis group and esophageal gastric stump end-to-side anastomosis group (P>0.05). The 5-year overall survival rate of these 3 groups was 48.7%, 46.3%and 50.2% respectively, and no significant difference was found (all P>0.05). Conclusion Modified double tracks anastomosis is an ideal surgical method for type Ⅱ-Ⅲ AEG.
