Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌全胃与近端胃切除术的疗效比较
Comparison of the efficacies of total gastrectomy and proximal gastrectomy for the treatment of Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction
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摘要:
目的：探讨Siewert Ⅱ、Ⅲ型食管胃结合部腺癌(AEG)全胃与近端胃切除术的临床疗效。
方法：回顾性分析2012年6月至10月安徽医科大学第一附属医院收治的63例Siewert Ⅱ、Ⅲ型AEG患者的临床资料。其中33例患者采用全胃切除术(全胃切除术组)，30例患者采用近端胃切除术(近端胃切除术组)，分析比较两组患者的根治效果、术后胃肠功能恢复与胃食管反流情况及肿瘤复发情况、生命质量等指标。计数资料采用χ2检验，计量资料采用t检验。
结果：全胃切除术组患者R0切除32例、R1切除1例， 近端胃切除术组患者R0切除22例、R1切除8例，两组比较，差异有统计学意义(χ2=10.177，P<0.05)。全胃切除术组和近端胃切除术组近端切缘长度分别为(4.1±1.4)cm和(3.9±1.6)cm，两组比较，差异无统计学意义 (t=0.666， P>0.05)；而远端切缘长度分别为(8.1±2.6)cm和(4.2±2.6)cm；淋巴结清扫数目分别为 (25±4) 枚和(21±4)枚；阳性淋巴结检出数目分别为(11±3)枚和(8±4)枚，两组比较，差异均有统计学意义(t=6.043，4.300，3.274，P<0.05)。全胃切除术组和近端胃切除术组术后肠鸣音恢复时间分别为(1.3±0.5)d和(1.6±0.5)d；肛门排气时间分别为(3.1±0.7)d和(3.5±0.7)d；进食时间分别为(4.7±1.0)d和(5.3±1.2)d；术后住院时间分别为(10.0±2.0)d和(12.0±2.0)d，两组比较，差异均有统计学意义(t=2.443，-2.059，-2.078，-4.037，P<0.05)。全胃切除术组和近端胃切除术组术后第6天胃液TBil分别为(13±10)μmol/L和(41±18)μmol/L；IBil分别为(7±6)μmol/L和(26±15)μmol/L；胆汁酸分别为(20±12)μmol/L和(204±88)μmol/L；术后6个月反流性疾病问卷(RDQ)评分分别为(14±3)分和(19±5)分；术后6个月胃食管反流病问卷(GERD Q)评分分别为(9.7±2.3)分和(12.0±2.5)分，两组比较，差异均有统计学意义(t=7.544，-6.251，-11.379，-4.765，-3.882，P<0.05)。全胃切除术组和近端胃切除术组患者术后6个月血清CEA水平为(3.8±2.6)μg/L和(5.4±2.0)μg/L，两组比较，差异有统计学意义(t=2.611，P<0.05)。
结论：全胃切除术治疗Siewert Ⅱ、Ⅲ型AEG患者的根治效果、术后胃肠功能恢复、胃食管反流和肿瘤复发等方面均优于近端胃切除术。Abstract:Objective:To compare the clinical efficacies of total gastrectomy (TG) and proximal gastrectomy (PG) in treating Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).
Methods:The clinical data of 63 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to the First Affiliated Hospital of Anhui Medical University from June 2012 to October 2012 were retrospectively analyzed. All the patients were divided into the TG group (33 cases) and the PG group (30 cases). The efficacy of radical resection, recovery of gastrointestinal function, postoperative esophageal reflux, postoperative tumor recurrence and postoperative quality of life of the 2 groups were compared. The count data and the measurement data were analyzed using the chi square test and the t test, respectively.
Results:The numbers of patients who received and R1 resection in the TG group were 32 and 1, which were significantly different from 22 and 8 in the PG group (χ2=10.177, P<0.05). The lengths of proximal resection margins were (4.1± 1.4)cm in the TG group and (3.9±1.6)cm in the PG group, with no significant difference between the 2 groups (t=0.666, P>0.05). The length of distal resection margin, number of lymph nodes resected, lymph nodes with positive expression were (8.1±2.6)cm, 25±4, 11±3 in the TG group, and (4.2±2.6)cm, 21±4 and 8±4 in the PG group, with significant differences between the 2 groups (t=6.043, 4.300, 3.274, P<0.05). The time for bowel sound restoration, time to first flatus, time to diet and duration of postoperative hospital stay were (1.3±0.5)days, (3.1±0.7)days, (4.7±1.0)days and (10.0±2.0)days in the TG group, and (1.6± 0.5)days, (3.5±0.7)days, (5.3±1.2)days and (12.0±2.0)days, with significant differences between the 2 groups (t= -7.544,-6.251, -11.379, -4.765,-3.882, P<0.05). The levels of serum carcinoembryonic antigen at postoperative month 6 were (3.8±2.6)μg/L in the TG group and (5.4±2.0)μg/L in the PG group, with significant difference (t= -2.611, P<0.05).
Conclusion:TG is superior to PG for the treatment of Siewert type Ⅱ and Ⅲ AEG in aspects of radical resection, perioperative recovery, seversity of gastroesophageal reflux and tumor recurrence.-
Keywords:
- Adenocarcinoma of the esophagogastric junction /
- Gastrectomy /
- Safety /
- Efficacy
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