CAJ | 학술논문

目的：探讨近端胃癌两种不同手术方式对患者术后生命质量、并发症和预后的影响。方法回顾性分析中山大学附属东华医院收治的102例近端胃癌患者临床资料，其中50例行近端胃癌根治性切除，残胃食管吻合（近端胃切除组）；52例行全胃切除，食管空肠 Roux-en-Y 吻合（全胃切除组）。比较两组的术后并发症、营养指标以及预后情况。结果两组患者术后反流性食管炎比较，近端胃切除组与全胃切除组发生率分别为38．0％和19．2％，差异有统计学意义（χ2＝4．464，P ＝0．035）。术后感染、出血、吻合口瘘发生率两组比较差异均无统计学意义（χ2＝0．063，P ＝1．000；χ2＝0．001，P ＝0．978；χ2＝0．311，P ＝0．577）。术后1年两组血浆总蛋白分别为（65．26±4．10）g／L、（65．33±3．75）g／L，白蛋白分别为（39．76±2．17）g／L、（39．59±2．04）g／L，血红蛋白分别为（107．33 ± 11．10）g／L、（108．09±11．17）g／L，术后体重分别减轻1．00～8．00 kg、0．50～8．20 kg，两组比较差异均无统计学意义（t ＝－0．402，P ＝0．688；t ＝1．778，P ＝0．076；t ＝－1．502，P ＝0．133；t ＝－1．622，P ＝0．105）。术后随访时间7个月至10年，两组术后吻合口复发率分别为4．0％和5．8％，肿瘤远处转移发生率分别为24．0％和28．8％，差异均无统计学意义（χ2＝0．171，P ＝0．679；χ2＝0．308，P ＝0．579）。两组中位生存期分别为53．6个月和49．8个月，生存率比较差异无统计学意义（χ2＝2．564，P ＝0．109）。结论与近端胃切除相比，全胃切除可有效减少术后反流性食管炎的发生，且不增加营养不良、肿瘤复发转移及死亡的发生率，是一种安全有效的手术方式。
목적：탐토근단위암량충불동수술방식대환자술후생명질량、병발증화예후적영향。방법회고성분석중산대학부속동화의원수치적102례근단위암환자림상자료，기중50례행근단위암근치성절제，잔위식관문합（근단위절제조）；52례행전위절제，식관공장 Roux-en-Y 문합（전위절제조）。비교량조적술후병발증、영양지표이급예후정황。결과량조환자술후반류성식관염비교，근단위절제조여전위절제조발생솔분별위38．0％화19．2％，차이유통계학의의（χ2＝4．464，P ＝0．035）。술후감염、출혈、문합구루발생솔량조비교차이균무통계학의의（χ2＝0．063，P ＝1．000；χ2＝0．001，P ＝0．978；χ2＝0．311，P ＝0．577）。술후1년량조혈장총단백분별위（65．26±4．10）g／L、（65．33±3．75）g／L，백단백분별위（39．76±2．17）g／L、（39．59±2．04）g／L，혈 홍 단백분별위（107．33 ± 11．10）g／L、（108．09±11．17）g／L，술후체중분별감경1．00～8．00 kg、0．50～8．20 kg，량조비교차이균무통계학의의（t ＝－0．402，P ＝0．688；t ＝1．778，P ＝0．076；t ＝－1．502，P ＝0．133；t ＝－1．622，P ＝0．105）。술후수방시간7개월지10년，량조술후문합구복발솔분별위4．0％화5．8％，종류원처전이발생솔분별위24．0％화28．8％，차이균무통계학의의（χ2＝0．171，P ＝0．679；χ2＝0．308，P ＝0．579）。량조중위생존기분별위53．6개월화49．8개월，생존솔비교차이무통계학의의（χ2＝2．564，P ＝0．109）。결론여근단위절제상비，전위절제가유효감소술후반류성식관염적발생，차불증가영양불량、종류복발전이급사망적발생솔，시일충안전유효적수술방식。
Objective To evaluate the impacts of the two different gastrectomy methods on the quality of life,complication and prognosis in proximal gastric cancer.Methods One hundred and two cases of proxi-mal gastric cancer in Tung Wah Hospital were collected for retrospective analysis.They were divided into proxi-mal gastrectomy/gastroesophagostomy (PG)group (n =50)and total gastrectomy/esophagojejunostomy (TG) group (n =52),according to the methods of gastrectomy and reconstruction.The postoperative complications, nutritional status and prognosis of the two groups were compared.Results The incidence of reflux esophagitis was obviously higher in PG group than that in TG group (38.0% vs 1 9.2%,χ2 =4.464,P =0.035).No sig-nificant differences were found between the two groups in the incidences of postoperative infection,bleeding and anastomotic leakage (χ2 =0.063,P =1 .000;χ2 =0.001 ,P =0.978;χ2 =0.31 1 ,P =0.577).There were no significant differences between PG and TG group in total plasma protein [(65.26 ±4.1 0)g/L vs (65.33 ± 3.75)g/L,t =-0.402,P =0.688],albumin [(39.76 ±2.1 7)g/L vs (39.59 ±2.04)g/L,t =1 .778,P =0.076],hemoglobin [(1 07.33 ±1 1 .1 0)g/L vs (1 08.09 ±1 1 .1 7)g/L,t =-1 .502,P =0.1 33]and weight loss [1 .00 ~8.00 kg vs 0.50 ~8.20 kg,t =-1 .622,P =0.1 05]in one year postoperatively.All cases were followed-up for 7 months to 1 0 years.No significant differences were found between PG and TG group in the incidences of anastomotic tumor recurrence (4.0% vs 5.8%,χ2 =0.1 71 ,P =0.679),metastasis (24.0% vs 28.8%,χ2 =0.308,P =0.579)and median survival time (53.6 months vs 49.8 months,χ2 =2.564,P =0.1 09).Conclusion Compared with PG group,the incidence of postoperative reflux esophagitis is effectively reduced,and the incidences of malnutrition,tumor recurrence and metastasis and death are not increased in TG group.Hence,TG should be a safe and effective surgery strategy.