赵桂斌　江　川　李成贻

福建医科大学附属闽东医院肿瘤科，福建福安355000

近端胃切除附加幽门成形术治疗胃上部癌的临床研究

赵桂斌江川李成贻▲

福建医科大学附属闽东医院肿瘤科，福建福安355000

目的探讨近端胃切除附加幽门成形术在胃上部癌消化道重建中的临床应用价值。方法将56例胃上部癌患者分成两组，A组（30例）行近端胃切除附加幽门成形术；B组（26例）行全胃切除食管空肠Roux-en-Y吻合术。比较两组患者术后14 d、1个月、3个月的血红蛋白、血浆白蛋白和体重变化；术后3个月残胃与“代胃”的容量及钡剂排空时间；术后6个月残胃与“代胃”的吻合口炎及反流情况。结果A组在血红蛋白、血浆白蛋白和体重变化方面优于B组，差异具有统计学意义（P＜0.05）。A组残胃与“代胃”的容量比较，差异具有统计学意义［（260.0±30.0）mL vs（110.0±25.0）mL，P＜0.05）］。A组残胃与“代胃”的钡剂排空时间比较，差异具有统计学意义［（2.6±0.5）h vs（1.2±0.3）h，P＜0.05）］。两组术后6个月吻合口炎及反流情况比较，差异无统计学意义（P＞0.05）。结论近端胃切除附加幽门成形术是胃上部癌术后消化道重建的一种较合理术式。

胃上部癌；近端胃切除附加幽门成形术；食管空肠Roux-en-Y吻合术

［Abstract］Objective To discuss the clinical application value of proximal gastrectomy combined with pyloroplasty in the reconstruction of gastrointestinal tract after surgery of upper gastric cancer.Methods A total of 56 patients with upper gastric cancer were assigned to two groups.Group A（30 patients）were given proximal gastrectomy combined with pyloroplasty；Group B（26 patients）were given total gastrectomy combined with Roux-en-Y esophagojejunostomy. Hemoglobin，plasma albumin and weight changes were compared between the two groups of patients 14 days，1 month and 3 months after the surgery；the volume and evacuation time of the residual stomach and"gastric substitute"were compared 3 months after the surgery；anastomositis and reflux of the residual stomach and"gastric substitute"were compared 6 months after the surgery.Results Hemoglobin，plasma albumin and weight changes in group A were better than those in group B，and the differences were statistically significant（P＜0.05）.The volume of the residual stomach and "gastric substitute"in group A was compared，and the difference was statistically significant［（260.0±30.0）mL vs（110.0± 25.0）mL，P＜0.05］.Evacuation time of barium in the residual stomach and"gastric substitute"in group B was compared，and the difference was statistically significant［（2.6±0.5）h vs（1.2±0.3）h，P＜0.05］.The diffrence of anastomositis and reflux of the residual stomach and"gastric substitute"at 6 months after the surgery was not statistically significant（P＞0.05）.Conclusion Proximal gastrectomy combined with pyloroplasty is a reasonable surgical procedure for the reconstruction of gastrointestinal tract after surgery of upper gastric cancer.

［Key words］Upper gastric cancer；Proximal gastrectomy combined with pyloroplasty；Roux-en-Y esophagojejunostomy

胃上部癌早期临床症状不典型，多数患者就诊时已为晚期，若不采取有效治疗会危及患者的生命［1］。胃上部癌包括贲门癌（癌中心位于食管-胃连接线上下2 cm以内）和非贲门上部癌（癌中心位于胃底及小弯侧上1/3处）。手术切除是治疗胃上部癌的首选方法，包括近端胃切除附加幽门成形与全胃切除术，近年行全胃切除的患者增多，但全胃切除术后的饮食受限、营养障碍、消化道反流等严重影响患者术后的生活质量，学术界对手术术式的选择争议很大。……