CAJ | 학술논문

目的：探讨近端胃癌根治术不同手术方式及重建方式对患者长短期预后的影响。方法将120例近端胃癌患者随机分为PG-EG、TG-RY、PG-JI 3组，3组患者的手术方式及重建方式不同。观察3组患者的围手术期以及近远期并发症对患者的影响。结果3组患者在手术时间、术中出血量以及淋巴结清扫个数上的差异具有统计学意义（P＜0．05），且TG-RY组的手术时间、术中出血量以及淋巴结清扫个数上明显比其余2组多。但是3组在术后感染率、吻合口瘘发生率以及肠梗阻的发生上差异不具有统计学意义（P＞0．05）。3组相比较，远期并发症如倾倒综合征以及碱性反流性胃炎存在明显差异，具有统计学意义（P＜0．05），且TG-RY组这两种并发症的发生率比其余2组高。但是3组在随访中在肿瘤的复发率上差异不具有统计学意义（P＞0．05）。3组患者在随访中发现，患者的无瘤生存率在1年（92．5％，95．0％，95．0％）、3年（57．5％，62．5％，60．0％）以及5年（19．0％，17．0％，20．0％）上没有明显差异，不具有统计学意义（P＞0．05）。结论 PG-EG、TG-RY、PG-JI 3种手术及重建方式各有利弊，应根据患者的具体实际情况选择手术及重建方式以期达到最佳治疗效果。
목적：탐토근단위암근치술불동수술방식급중건방식대환자장단기예후적영향。방법장120례근단위암환자수궤분위PG-EG、TG-RY、PG-JI 3조，3조환자적수술방식급중건방식불동。관찰3조환자적위수술기이급근원기병발증대환자적영향。결과3조환자재수술시간、술중출혈량이급림파결청소개수상적차이구유통계학의의（P＜0．05），차TG-RY조적수술시간、술중출혈량이급림파결청소개수상명현비기여2조다。단시3조재술후감염솔、문합구루발생솔이급장경조적발생상차이불구유통계학의의（P＞0．05）。3조상비교，원기병발증여경도종합정이급감성반류성위염존재명현차이，구유통계학의의（P＜0．05），차TG-RY조저량충병발증적발생솔비기여2조고。단시3조재수방중재종류적복발솔상차이불구유통계학의의（P＞0．05）。3조환자재수방중발현，환자적무류생존솔재1년（92．5％，95．0％，95．0％）、3년（57．5％，62．5％，60．0％）이급5년（19．0％，17．0％，20．0％）상몰유명현차이，불구유통계학의의（P＞0．05）。결론 PG-EG、TG-RY、PG-JI 3충수술급중건방식각유리폐，응근거환자적구체실제정황선택수술급중건방식이기체도최가치료효과。
Objective To study the effect of different tumor resection and reconstruction scheme in proximal gastric cancer on prognosis.Methods 120 patients diagnosed as proximal gastric cancer were randomly divided into PG-EG group,TG-RY group,and PG-JI group.The 3 groups received different operation and reconstructions methods.Effect of perioperative,short-term and long-term complications on patients were observed.Results There had statistically significant difference in the 3 groups in operative time,bleeding volume,and lymph node dissection number (P<0.05),and operative time,bleeding volume,and lymph node dissection number of TG-RY group were significantly higher than those of the other 2 groups.But the 3 groups had no statistically significant difference in infection,anastomotic leakage rate and intestinal obstruction occurrence rate (P>0.05).The long-term complications such as dumping syndrome and alkaline reflux gastritis had obvious difference in the 3 groups,( P<0.05),and dumping syndrome and alkaline reflux gastritis of TG-RY group had higher incidence than those of the other 2 groups. There had no statistically significant difference in the 3 groups in tumor recurrence rate ( P>0.05) .There had no statistically sig-nificant difference in the 3 groups (P>0.05)in 1-year tumor free survival rates (92.5%,95.0%,95.0%),3-year tumor free survival rates(57.5%,62.5%,60.0%) and 5-year tumor free survival rates(19.0%,17.0%,20.0%).Conclusion PG-EG, TG-RY,PG-JI have advantages and disadvantages,actual situation of patients should be considered in selecting specific operation and reconstruction mode,in order to achieve the best therapeutic effect.