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中华普通外科学文献(电子版) ›› 2017, Vol. 11 ›› Issue (06) : 406 -409. doi: 10.3877/cma.j.issn.1674-0793.2017.06.011

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论著

Ⅱ、Ⅲ型食管胃结合部腺癌行近端胃切除间置空肠吻合术疗效分析
文家治1,()   
  1. 1. 710016 西安市长安医院普外科
  • 收稿日期:2017-09-15 出版日期:2017-12-01
  • 通信作者: 文家治

Analysis of curative effect of proximal gastrectomy combined with jejunum anastomosis in typeⅡ andⅢesophageal adenocarcinoma

Jiazhi Wen1,()   

  1. 1. Department of General Surgery, Chang’an Hospital of Xi’an City, Xi’an 710016, China
  • Received:2017-09-15 Published:2017-12-01
  • Corresponding author: Jiazhi Wen
  • About author:
    Corresponding author: Wen Jiazhi, Email:
引用本文:

文家治. Ⅱ、Ⅲ型食管胃结合部腺癌行近端胃切除间置空肠吻合术疗效分析[J/OL]. 中华普通外科学文献(电子版), 2017, 11(06): 406-409.

Jiazhi Wen. Analysis of curative effect of proximal gastrectomy combined with jejunum anastomosis in typeⅡ andⅢesophageal adenocarcinoma[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2017, 11(06): 406-409.

目的

探讨Ⅱ、Ⅲ型食管胃结合部腺癌(AEJ)患者行近端胃切除间置空肠吻合术后的远期临床疗效。

方法

选择2014年1月至2017年1月西安市长安医院收治的Ⅱ、Ⅲ型AEJ患者共132例为研究对象,根据手术方式分为研究组和对照组,其中研究组62例,行近端胃切除(PG)+间置空肠吻合术;对照组70例,行全胃切除(TG)+Roux-en-Y吻合术。比较2组患者术后反流性食管炎、颠倒综合征等并发症发生率,以及手术前后营养状况及免疫功能指标。

结果

研究组患者术后半年内反流性食管炎发生率、颠倒综合征发生率分别为22.6%、1.6%,显著低于对照组的64.3%、7.1%,差异有统计学意义(χ2=23.135、2.317,P<0.01、0.021)。与术前比较,术后6个月时2组患者血清总蛋白、白蛋白、血红蛋白水平较术前均显著降低,LgA、LgG及CD4+/CD8+比值均显著增高(均P<0.05)。组间比较,术后6个月时研究组营养状况、体质量减重水平均显著低于对照组,差异有统计学意义(均P<0.05),但各项免疫功能指标组间差异无统计学意义。

结论

Ⅱ、Ⅲ型AEJ患者行近端胃切除间置空肠吻合术可显著改善患者远期生活质量,提高患者营养状况及免疫功能,且并发症较少,具有较广泛的远期临床应用价值。

Objective

To explore the long-term clinical value of proximal gastrectomy combined with jejunal anastomosis for typeⅡ andⅢ adenocarcinoma of esophagogastric junction(AEJ) patients.

Methods

A total of one hundred and thirty-two patients with typeⅡ andⅢ AEJ were enrolled in this study from January 2014 to January 2017 in Chang’an Hospital of Xi’an City. The patients were divided into study group (62 cases) and control group (70 cases) according to the operation. The study group underwent proximal gastrectomy (PG) + interposition jejunum anastomosis, the control group underwent total gastrectomy (TG) + Roux-en-Y anastomosis. The incidence of complications such as reflux esophagitis and inverted syndrome, the nutritional status and immune function of the two groups were compared before and after operation.

Results

The incidence of reflux esophagitis and the incidence of inverted syndrome were 22.6% and 1.6% in the study group, lower than 64.3% and 7.1% in the control group respectively (χ2=23.135, 2.317, P<0.01, 0.021). Compared with the preoperative levels, the serum total protein, albumin and hemoglobin levels of the two groups were significantly lower 6 months after operation. The ratio of LgA, LgG and CD4+/CD8+ increased significantly (all P<0.05). Between the two groups, nutritional status, body weight loss in study group were significantly lower than the control group, the differences were statistically significant (both P<0.05), but there was no significant difference in immune function indexes.

Conclusion

The combination of proximal gastrectomy for typeⅡandⅢ AEJ patients can improve the long-term quality of life and improve the nutritional status and immune function of the patients, with less complications of long-term clinical value.

表1 2组Ⅱ、Ⅲ型AEJ患者一般资料比较
表2 2组AEJ患者围手术期并发症发生率比较[例(%),χ2检验]
表3 2组AEJ患者术前及术后6个月营养状况对比(±st检验)
表4 两组AEJ患者术前及术后免疫功能指标对比(±s
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