张锐++李霄

[摘要] 目的 兩种经腹手术入路治疗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）。两组患者围术期并发症的发生率差异无统计学意义（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）。两组患者在术后1年的营养状况差异无统计学意义（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， Xi'an 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）； There were no statistically significant differences in occurrence rate of complications during perioperative period between the two groups （P > 0.05）. Compared with total gastrectomy group， proximal gastrectomy group was more licked to occured the esophagogastricl reflux after operation 1 year， the differences were statistically significant （P < 0.05）. There was statistically significant difference in nutritional status between the two groups after operation 1 year （P > 0.05）. The survival rate of the two groups had no statistically significant difference after operation 5 years （P > 0.05）， 5-year survival rate of Ⅲ phase patients in total gastrectomy group was 12.50%， that in proximal gastrectomy group was 10.53%. Conclusion The occurrence rate of esophagogastric reflux for total gastrectomy is significantly lower than proximal gastrectomy and the risk of operation will not be increased， there is no significant difference between total gastrectomy and proximal gastrectomy in postoperative nutritional status， it is a suitable operation method for Siewert Ⅱ type and Ⅲ type AEG patients.

[Key words] Adenocarcinoma of esophagogastric junction； Total gastrectomy； Proximal gastrectomy； Curative effective

食管胃结合部腺癌（AEG）是指肿瘤中心位于齿状线及远近端各5 cm范围内的腺癌[1-2]。外科手术是主要治疗方法[3-4]，常采用近端胃切除术或全胃切除术。本文旨在探讨治疗SiewertⅡ、Ⅲ型AEG较为合适的手术方式，从而改善患者生存质量。

1 资料与方法

1.1 一般资料

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。术……