探讨近端胃切除与全胃切除治疗贲门癌的近期和远期临床疗效。

回顾性分析老河口市第一医院2009年1月至2013年1月收治的185例行根治性手术治疗的贲门癌患者，其中近端胃切除（近端组）79例，全胃切除（全胃组）106例，比较两组患者手术相关情况、远期生存和并发症。

两组患者均顺利完成手术，无围手术期死亡病例。全胃组手术时间和手术出血量均高于近端组（t=5.015、3.852，均P<0.01），但两组患者的术后住院时间和围手术期并发症发生率差异并无统计学意义。随访时间6.2~71.5个月，随访率为88.6%。近端组1、3、5年总生存率为75.3%、28.4%、19.3%；全胃组1、3、5年总生存率为80.0%、46.8%、32.7%。两组之间的总生存率差异有统计学意义（P=0.010），但两组患者Ⅰ期、Ⅱ期及Ⅲ期总生存率比较，差异均无统计学意义。近端组术后吻合口狭窄发生率和术后1年胃食管反流问卷（GERD-Q）评分高于全胃组（均P<0.05），但两组吻合口溃疡、粘连性肠梗阻发生率和术后1年营养风险筛查评估表-2002（NRS-2002）评分比较，差异并无统计学意义。

较近端胃切除，全胃切除术治疗贲门癌可以提高远期生存率，降低吻合口狭窄发生率，减轻反流症状。

To compare the clinical efficacy of proximal gastrectomy with total gastrectomy for cardia carcinoma.

The clinical data of one hundred and eighty-five patients with cardia carcinoma from January 2009 to January 2013 were reviewed, and 79 cases underwent proximal gastrectomy (proximal group), 106 cases underwent total gastrectomy (total gastrectomy group). The operation, long-term survival and complications were compared between the two groups.

All of the patients underwent the operation successfully. The operation time and blood loss in the total group were higher than those in the proximal group (t=5.015, 3.852, both P<0.01), but the hospital stay and incidence of perioperative complications were comparable in the two groups. The follow-up duration ranged from 6.2 to 71.5 months, and the follow-up rate was 88.6%. The 1-, 3-, and 5-year overall survival rate in the proximal group was 75.3%, 28.4% and 19.3% respectively, and 80.0%, 46.8% and 32.7% respectively in the total group. There was significant difference in the overall survival between the two groups (P=0.010). But the differences in the overall survival of stage, Ⅱ and Ⅲ between the two groups were not statistically significant. The incidence of anastomotic stenosis and 1-year score of gastroesophageal reflux disease questionnaire (GERD-Q) in the proximal group were higher than those in the total group (both P<0.05), but the differences of marginal ulcer, adhesive ileus and score of nutrition risk screening 2002 (NRS-2002) between the two groups were not significant.

Compared with proximal gastrectomy, total gatrectomy can improve the overall survival, reduce the incidence rate of anastomotic stenosis and reflux symptoms for cardia carcinoma.