胃底贲门癌根治术后三种消化道重建方式的疗效比较

目的：比较三种消化道重建方式在根治性胃切除术治疗胃底贲门癌过程中的应用效果。方法收集150例接受根治性胃切除术治疗胃底贲门癌患者，根据消化道重建方式分为A组（55例）、B组（46例）、C组（49例），A组患者接受间置空肠吻合术，B组患者接受食管空肠Roux-en-Y吻合术，C组患者接受食管残胃后壁吻合术。术后随访12个月。结果随访期内，A组反流性食管炎发生率显著低于B组（1．82％比19.57％，χ^2=6．966，P＝0．008），B组患者反流性食管炎发生率显著低于C组（χ^2=4.212，P＝0．042）。手术后12个月，A组患者整体健康状况、便秘、腹泻、恶心呕吐等指标评分显著低于B组与C组（均P＜0．05）。结论根治性全胃切除术治疗胃底贲门癌时可以选择食管空肠Roux-en-Y吻合术；近端根治性胃切除术治疗胃底贲门癌过程中应用间置空肠吻合术具有术后反流性食管炎发生率低、患者生存质量高等优点。

Comparative analysis of three kinds of digestive tract reconstruction after radical gastrectomy in the treat-ment of gastric cardia carcinoma

Objective To compare the effects of three kinds digestive tract reconstruction after radical gas-trectomy for gastric cardia carcinoma.Methods The data of 150 patients underwent radical gastrectomy for gastric cardia cancer patients were analyzed.According to the reconstruction of digestive tract,they were divided into group A （55 cases）,group B （46 cases）,group C（49 cases）.Patients in group A underwent jejunal anastomosis.Patients in group B underwent esophageal empty intestine Roux-en-Y anastomosis.Patients in group C underwent esophageal gas-tric wall anastomosis.All were follow-up for 12 months.Results During the follow-up period,the rate of reflux esoph-agitis in group A were significantly lower than that in B group （1.82%vs 19.57%,χ^2=6.966,P=0.008）,the rate of reflux esophagitis in B group were significantly lower than that in C group （19.57%vs 38.78%,χ^2=4.212,P=0.042） .12 months after operation,overall health,constipation,diarrhea,nausea and vomiting index score of group A was significantly lower than those of group B and group C （all P〈0.05）.Conclusion The esophagus jejunum Roux-en-Y anastomosis is suitable for radical total gastrectomy in the treatment of gastric cardia carcinoma.The jeju-nal interposition anastomosis after proximal radical gastrectomy in the treatment of gastric cardia carcinoma shows low incidence of reflux esophagitis and high quality of life.