| 文增瑞,姜鑫,孙翔翔,等.不同手术入路对近端胃切除术治疗Siewert Ⅱ型食管胃结合部腺癌的效果对比[J].中国临床保健杂志,2021,24(3):418-423. |
| 不同手术入路对近端胃切除术治疗Siewert Ⅱ型食管胃结合部腺癌的效果对比 |
| Comparison of the effects of different surgical approaches for proximal gastrectomy in the treatment of Siewert type Ⅱ adenocarcinoma of esophagogastric junction |
| 投稿时间：2021-04-28 |
| DOI：10.3969/J.issn.1672-6790.2021.03.030 |
| 中文关键词: 胃切除术 淋巴结切除术 治疗结果 生活质量 手术后并发症 |
| 英文关键词: Gastrectomy Lymph node excision Treatment outcome Quality of life Postoperative complications 〖FL |
| 基金项目:安徽省自然科学基金项目(1708085MH182);吴阶平医学基金项目(320.2730.1899) |
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| 中文摘要: |
| 目的 对比分析Siewert Ⅱ型食管胃结合部腺癌行近端胃切除术采用经胸及经腹两种不同手术路径的临床疗效。方法 回顾性分析2015年9月至2017年12月在安徽省立医院行近端胃切除术的Siewert Ⅱ型食管胃结合部腺癌的患者。根据手术入路不同,分为经胸组(48例)和经腹组(27例)。收集临床资料和术后回访数据,比较两组患者的术中情况、围手术期并发症、术后生存率及生活质量。结果 两组患者性别、年龄、肿瘤的大小、分化程度及TNM分期差异无统计学意义。经胸入路组相较于经腹入路组,胸腔淋巴结清扫数目更多,差异有统计学意义(P＜0.001)；后者腹腔淋巴结清扫数目更多,差异有统计学意义(P＜0.01),但两组术后淋巴结阳性率及阳性淋巴结站数差异无统计学意义。经腹组术后引流量、术后下床时间、术后住院天数及住院总费用明显低于经胸组,差异有统计学意义(P＜0.001),而手术时间、术中出血量差异无统计学意义。经胸组肺部并发症高于经腹组(P＜0.05),其余术后并发症差异无统计学意义。两组患者1年生存率、3年生存率及总体平均生存期差异无统计学意义,但经腹组1、3、6月术后总体健康状态、躯体功能、情绪功能、社会功能评分相较于经胸组下降明显(P＜0.05)；术后恶心呕吐、食欲减退、反流发生率明显升高(P＜0.05),经胸组术后疼痛明显(P＜0.05)。两组患者术后角色功能和认知功能上较术前降低,疲倦、气促、失眠、便秘、腹泻、经济困难方面均较术前明显,但差异无统计学意义(P＞0.05)。结论 经胸入路行近端胃切除术治疗Siewert Ⅱ型食管胃结合部腺癌,肿瘤食管段切除、胸腔淋巴结的清扫及术后总体生活质量优于经腹入路手术；但经腹入路方式清扫腹腔淋巴结更具优势,且手术创伤小,术后并发症较少。 |
| 英文摘要: |
| Objective Compare and analyze the clinical efficacy between transthoracic and transabdominal proximal gastrectomy in treatment of Siewert type Ⅱ adenocarcinoma of esophagogastric junction.Methods Retrospective study were made among patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction who underwent proximal gastrectomy in Anhui Provincial Hospital from September 2015 to December 2017 were selected.According to different surgical approaches,patients were divided into two groups,as transthoracic approach group (48 cases) and transabdominal approach group (27 cases).Clinical data and postoperative follow-up data were collected to compare the intraoperative conditions,perioperative complications,postoperative survival rate and quality of life between the two groups.Results There was no significant difference in gender,age,tumor size,degree of differentiation and TNM stage between two groups.The number of thoracic lymph nodes dissected in transthoracic approach group was more than that in transabdominal approach group,and the difference was statistically significant(P＜0.001).Abdominal lymph nodes dissection were more thorough in the transabdominal approach group compared with the transthpracic approach group (P＜0.01).However,there was no significant difference in the positive rate of lymph nodes and the number of positive lymph node stations between the two groups.Except the operative time and intraoperative blood loss,evaluation indicators were statistically significant reduced in the transthoracic approch group compared with the transabdominal approach group such as postoperative drainage volume,postoperative time out of bed,postoperative days of hospitalization and total hospitalization cost (P＜0.001).Pulmonary complications in the transthoracic approach group were higher than those in the transabdominal approach group (P＜0.05),while there was no significant difference in other postoperative complications.There was no significant difference in 1-year survival rate,3-year survival rate and overall average survival time between the two groups,but the scores of overall health status,physical function,emotional function and social function in the transabdominal approach group at 1,3 and 6 months after surgery were significantly lower than those in the transthoracic approach group (P＜0.05).The incidence of postoperative nausea and vomiting,anorexia and reflux were significantly increased in the transabdominal approach group(P＜0.05),and postoperative pain was significantly increased in the transthoracic approach group (P＜0.05).The postoperative role function and cognitive function of the two groups of patients were lower than that before the operation.Fatigue,shortness of breath,insomnia,constipation,diarrhea,and financial difficulties were all significantly lower than that before the operation,but the difference was not statistically significant.Conclusion Transthoracic approach proximal gastrectomy is superior to transabdominal approach in the resection of esophageal segment,dissection of thoracic lymph nodes and postoperative overall quality of life in treatment of Siewert type Ⅱ adenocarcinoma of esophagogastric junction,while the latter is more advantageous in dissecting abdominal lymph nodes,with less surgical trauma and less postoperative complications. |
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