Comparison of effective of two operation methods for treating Siewert Ⅱ type and Ⅲ type adenocarcinoma of esophagogastric junction via abdominal approach
ZHANG Rui1 LI Xiao2▲
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.
张锐1 李霄2▲. 两种经腹手术入路治疗SiewertⅡ型和Ⅲ型食管胃结合部腺癌的效果比较[J]. 中国医药导报, 2017, 14(26): 79-82.
ZHANG Rui1 LI Xiao2▲. Comparison of effective of two operation methods for treating Siewert Ⅱ type and Ⅲ type adenocarcinoma of esophagogastric junction via abdominal approach. 中国医药导报, 2017, 14(26): 79-82.
[1] Xiao-BoY，Qiang L，Xiong Q，et al. Efficacy of early postoperative enteral nutrition in supporting patients after esophagectomy [J]. Minerva Chir，2014，69（1）：37-46.
[2] Woo J，Lee JH. Shimm KN，et al. Dose the difference of invasiveness between totally laparoscopic distal gastrectomy and laparoscopy-assisted distal gastrectomy lead to a ddifference in early surgical outcomes? a prospective randomized trial [J]. Ann Surg Oncol，2015，22（6）：1836-1843.
[3] 季加孚.不断提高我国胃癌规范化治疗水平[J].中华普外科手术学杂志：电子版，2013，7（1）：1-3.
[4] Nakamura M，Yamaue H. Reconstruction after proximal gastrectomy for gastric cancer in the upper third of the stomach：a revew of the literature published from 2000 to 2014 [J]. Surg Today，2016，46（5）：517-527.
[5] 秦新裕，刘凤林.理念与技术并重，提高食管胃结合部腺癌综合治疗水平[J].中国实用外科杂志，2012，32（4）：261-263.
[6] 凌佳倩，王聪，刘凤林.淋巴结清扫术对进展期G3级胃癌预后的影响分析[J].中华胃肠外科杂志，2014，17（7）：670.
[7] Wei ZW. Systematic review of nasogastric or nasojejunal decompression after gastrectomy for gastric cancer [J]. Eur J Surg Oncol，2014，40（12）：1763-1770.
[8] Bu ZD，Ji JF. Controversies in the diagnosis and management of early gastric cancer [J]. Chinese J Cancer Res，2013，25（3）：263-266.
[9] 王丹，邢沫.5个肿瘤病种实施临床路径对缩短住院日和降低次均费用的效果分析[J].中国医院，2013（10）：32-33.
[10] Mukasa M，Takedatsu H，Matsuo K，et al. Clinical characteristics and management of gastric tube cancer with endoscopic submucosal dissection [J]. World J Gastroentero，2015，21（3）：919 -925.
[11] 薛英威，于雪峰.近端胃癌切除术后消化道重建方式[J].中华胃肠外科杂志，2014，17（5）：424-426.
[12] 钱锋，严鹏，刘军言，等.食管胃结合部腺癌手术方式的选择[J].中华消化外科杂志，2014，13（2）：120-125.
[13] Tokunaga M，Sano T，Ohyama S，et al. Clinicopathological characteristics and survival difference between gastric stump carcinoma and primary upper third gastric cancer [J]. Ann Surg Oncol，2013，17（2）：313 -318.
[14] 杨婷，王国俊，冯碧敏，等.雷莫芦单抗治疗胃或胃食管结合部腺癌疗效与安全性的Meta分析[J].中国药房，2016，27（6）：789-792.
[15] 刘骥，李雪，李纪鹏，等.S100A3在胃癌组织中表达及临床意义[J].空军医学杂志，2016，32（2）：91-93.
[16] 吴磊.老年食管癌误诊为心绞痛1例[J].空军医学杂志，2016，32（4）：289.
[17] 张希东.反流性食管炎误诊为心绞痛8例分析[J].空军总医院学报，2008，24（3）：168.
[18] Morgagni P，Gardini A，Marrelli D，et al. Gastric stump carcinoma after distal subtotal gastrectomy for early gastric cancer：experience of 541 patients with long-term follow-up [J]. Am J Surg，2014，（14）：379-371.
[19] Yu Z. Fast-track surgery in gastrectomy for gastric cancer：A systematic review and Meta-analysis [J]. Langenbeck Arch Surg，2014，399（1）：85-92.
[20] Nomura E，Lee SW，Kawai M，et al. Functional outcomes by reconstruction technique following laparoscopic proximal gastrectomy for gastric cancer：double tract versus jejunal interposition [J]. World J Surg Oncol，2014，12（1）：20.
[21] 金新天，王强，张依军，等.重建贲门、胃底预防食管癌术后反流性食管炎的临床价值分析[J].癌症进展，2016， 14（11）：1094-1097，1107.
2017, Vol. 14 
京公网安备 11010502046598号