两种经腹手术入路治疗SiewertⅡ型和Ⅲ型食管胃结合部腺癌的效果比较.docVIP

两种经腹手术入路治疗SiewertⅡ型和Ⅲ型食管胃结合部腺癌的效果比较 　　[摘要] 目的 ?芍志?腹手术入路治疗SiewertⅡ型和Ⅲ型食管胃结合部腺癌（AEG）的效果比较，即全胃切除和近端胃切除的疗效比较。 方法 回顾性分析2007年10月～2011年5月宝鸡市中医医院普外科接受手术治疗的SiewertⅡ、Ⅲ型AEG患者51例的临床资料，其中全胃切除术32例，近端胃切除术19例。比较两组患者年龄、临床病理特征、手术时间及术中出血量、术后病理分期、营养状态及术后生存情况。 结果 全胃切除组在淋巴结清扫数上优于近端胃切除组，而在手术时间及术中出血则高于近端胃切除术，差异有统计学意义（P 0.05）。近端胃切除组较全胃切除组更容易在术后1年发生反流性食管炎，差异有统计学意义（P 0.05）。两组患者术后5年生存率差异无统计学意义（P 0.05），Ⅲ期患者全胃切除术组5年生存率为12.50%，而近端胃切除术组5年生存率为10.53%。 结论 全胃切除组的反流性食管炎的发生率明显低于近端胃切除组，且没有增加手术风险，在术后营养状态与近端胃切除无明显差异，是目前SiewertⅡ、Ⅲ型AEG患者较为合适的手术方式。 　　[关键词] 食管胃结合部腺癌；全胃切除；近端胃切除；疗效 　　[中图分类号] R735.1 [文献标识码] A [文章编号] 1673-7210（2017）09（b）-0079-04 　　1.Department of Surgery， Baoji Hospital of Traditional Chinese Medicine， Shaanxi Province， Baoji 721001， China； 2.Department of Hepatobiliary Surgery， Air Force Modical University （Fourth Military Medical University） Xijing Hospital， Shaanxi Province， Xian 710032， China 　　[Abstract] Objective To compare two operation methods for treating Siewert Ⅱ， Ⅲtype adenocarcinoma of esophagogastric （AEG） junction via abdominal approach， namely total gastrectomy and proximal gastrectomy. Methods The clinical data of 51 patients with Siewert Ⅱ，Ⅲ type AEG， from October 2007 to May 2011， in Department of Surgery， Baoji Hospital of Traditional Chinese Medicine， were analyzed retrospectively， among them， 32 cases were given total gastrectomy and 19 cases were given proximal gastrectomy. The differences in patients age， clinical and pathological characteristics， operation time， intra-operative blood loss， postoperative pathologic staging， nutritional status and postoperative survival situation between the two groups were compared. Results Total gastrectomy group was better on lymph nody excision than the proximal gastrectomy group， while average operation time and average intra-operative blood loss were higher than those of proximal gastrectomy， the differences were statistically significant （P 0.05）. Compared with total gastrectomy group， proximal gastrectomy group was more lic