近端胃癌根治术应用效果观察

【摘要】〓目的〓探讨全胃切除术与近端胃癌根治术对进展期近端胃癌(肿瘤直径>3 cm)患者术后并发症、营养状况和生活质量的影响。方法〓回顾性分析我院2002年1月至2008年12月近端胃癌患者85例,其中全胃切除术40例,近端胃癌根治术45例,调查术后营养状况、反流性食管炎发生率、术后胆囊结石发生率、5年生存率和术后生活质量。两组患者性别、年龄、肿瘤直径、手术时间、住院时间、住院费用、淋巴结清扫数目、术前营养指标和术后并发症均无统计学差异。结果〓全胃切除组和近端胃癌根治组患者中位生存期分别为41个月和46个月,5年生存率分别为52.5%(21/40)和55.6%(25/45),均无显著统计学差异(P>0.05)。全胃切除组和近端胃癌根治组术后反流性食管炎发生率分别为25.0%(10/40)和8.9%(4/45),有显著的统计学差异(P<0.05)。全胃切除组和近端胃癌根治组患者术后5年累计胆囊结石发生率分别为27.5%(11/40)和8.9%(4/45),有显著的统计学差异(P<0.05)。近端胃癌根治组术后血红蛋白、白蛋白、维生素B12和铁蛋白均显著高于全胃切除组,有统计学差异(142.2±10.6 vs. 128.4±11.4; 41.3±5.8 vs. 35.9±3.8; 271.5±39.7 vs. 184.5±24.6; 220.2±59.7 vs. 170.2±27.6; P<0.05)。近端胃癌根治组患者术后饮食情况和劳动情况均优于全胃切除组,有显著的统计学差异(P<0.05)。结论〓近端胃癌根治术不影响进展期近端胃癌(肿瘤直径>3 cm)患者5年生存率,可以降低术后反流性食管炎和胆囊结石发生率,改善术后营养状况和生活质量。     

Cáncer gástrico por laparoscopia: análisis de los datos del Registro Nacional de Cirugía Gástrica por Laparoscopia

Objective

To study the data from the Laparoscopic Gastric Surgery Spanish National Register of laparoscopic Gastric Surgery and to analyse the type of surgery, the conversion to laparotomy, postoperative complications and mortality.

Patients and Method

From March 2005 to July 2008, details of 302 laparoscopic gastric surgical interventions were sent to the Association of Spanish Surgeons web-site. Details of surgical technique, reconversion, clinical and pathological data, morbidity and mortality were collected and analysed.

Results

A total of 245 patients had gastric adenocarcinoma, 35 of them stromal tumours and 22 other gastric pathologies. In gastric adenocarcinoma patients, resection was performed in 232 cases (95%). The most frequent histology was intestinal, mainly located in the distal third of the stomach, with 34% of the tumours being locally advanced. D2 lymphadenectomy was performed in 117 cases, D1 in 105, and D0 in 6. Reconversion was needed in 21 cases (9%), with technical difficulty being the most frequent cause . Postoperative complications were reported in 72 patients (31%), with anastomotic leak being one of the most significant. Postoperative mortality was 6%, with sepsis due to anastomotic leak and cardiac or respiratory complications the most frequent causes. The mean hospital stay of patients without complications was 9.2±3 days.

Conclusions

Laparoscopic gastrectomy for gastric cancer is a feasible but technically demanding procedure. Potential benefits of minimal invasive surgery can be reduced due to a high rate of postoperative complications.     

Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis

Study design

A retrospective analysis of 150 adolescents who underwent spinal fusion for idiopathic scoliosis.

Objective

To analyse the incidence of the postoperative proximal junctional kyphosis after posterior fusion to the upper thoracic vertebra in adolescents with idiopathic scoliosis and to explore its risk factors.

Summary of background data

The reported incidence of the proximal junctional kyphosis after the posterior fusion in patients with idiopathic scoliosis varies depending on surgical methods and strategies adopted by the institution.

Methods

The changes in the Cobb angle of the proximal junctional kyphosis on the lateral spine X-ray were measured and the presence of PJK was recorded. The risk factors were screened using statistical analysis.

Results

PJK occurred in 35 out of 123 patients with an overall incidence of 28%. Among them, 28 patients (80%) experienced PJK within 1.5 years after surgery. The PJK-inducing factors included greater than 10° intraoperative decrease in thoracic kyphosis, thoracoplasty, the use of a pedicle screw at the top vertebra, autogenous bone graft and fusion to the lower lumbar vertebra (below L2).

Conclusions

There is a high incidence of postoperative proximal junctional kyphosis after posterior fusion to the upper thoracic vertebra within 1.5 years after surgery in adolescents with idiopathic scoliosis. In order to reduce its incidence, the risk factors for PJK should be carefully evaluated before surgery.     

Risk factors and management of intra-abdominal infection after extended radical gastrectomy

Background

This study elucidated risk factors and management for intra-abdominal infection after extended radical gastrectomy.

Methods

From 1988 to 2004, 2,076 patients with gastric cancer underwent extended radical gastrectomy at Taipei Veterans General Hospital. Risk factors for intra-abdominal infection were determined by analyzing clinicopathological factors, operative procedure, combined organ resection, operative time, blood loss, and associated disease(s). Management modalities were summarized.

Results

The overall complication rate was 18.7%. Eighty (3.9%) patients were found to have intra-abdominal infections. Age, prolonged operation time, and combined organ resection were the precipitating factors. These patients were categorized into 3 groups: intra-abdominal abscess with adequate drainage, intra-abdominal abscess without anastomotic leakage, and intra-abdominal abscess because of leakage. Adequate drainage was the primary treatment. Mortality rate was 22.5% (18), and the most common cause of mortality was intra-abdominal abscess caused by leakage.

Conclusions

Although expert surgical skills can minimize the incidence of intra-abdominal infection, management also requires experience and training.     

Laparoscopic Sleeve Gastrectomy: Our First 100 Patients

Background:

Laparoscopic sleeve gastrectomy is becoming a popular procedure for the morbidly obese patient. Its utilization as a standalone procedure has good results with weight loss in short- and midterm reports. The aim of this study was to assess our technique and whether it warranted any modifications in the early postoperative period.

Methods:

Our first 100 consecutive patients undergoing laparoscopic sleeve gastrectomy were retrospectively reviewed. Data analysis was conducted at 3 and 6 months to assess the percentage of excess body weight loss and comorbidity status change.

Results:

The percentage of excess body weight loss at the 3- and 6-month marks was 34.2% and 49.1%, respectively. Comorbidities were also improved at the 3- and 6-month marks. Hypertension resolved in 38%, hyperlipidemia resolved in 19%, and diabetes in 46%. Complication rate during the first 6 months was 10%. Major complications included 2 patients with postoperative bleeding, 2 patients with acute renal failure from dehydration, and 1 postoperative bleeding patient who developed a gastric fistula. No surgical reintervention was required for any complication.

Conclusion:

Our technique is a safe method that is easily reproducible and does not require any modification. Laparoscopic sleeve gastrectomy is an excellent surgical option with a low complication rate.     

Evaluation of symptoms related to reflux esophagitis in patients with esophagogastrostomy after proximal gastrectomy

Purpose

We investigated postoperative symptoms related to reflux esophagitis in patients who underwent esophagogastrostomy reconstruction after proximal gastrectomy (PG) by conducting a questionnaire survey.

Method

Quality of life was assessed using two different questionnaires, the gastrointestinal symptom rating scale (GSRS) for postoperative abdominal symptoms and F-scale for reflux esophagitis. The survey was conducted among 39 patients who underwent esophagogastrostomy after proximal gastrectomy for gastric cancer in the upper third of the stomach, and findings were compared with those in patients who underwent total gastrectomy (TG).

Results

The questionnaire was returned by 32 of 39 patients (82%) in the PG group and 40 of 45 patients (89%) in the TG group. On GSRS, the score for indigestion syndrome tended to be higher in the TG group than in the PG group (p?<?0.10), and the score for constipation was significantly higher in the PG group than in the TG group (p?<?0.05). The score for reflux syndrome, however, was almost the same in both groups. Similarly, there was no significant difference in the frequency of GERD symptoms between the PG and TG groups on F-scale questionnaire (47% vs. 63%, p?=?0.18).

Conclusions

Esophagogastrostomy after PG in an end-to-side manner with creation of acute angle at the anastomosis is not associated with an increased risk of reflux esophagitis compared with TG.     

Nuclear transit studies of patients with intractable chronic constipation reveal a subgroup with rapid proximal colonic transit

Aims/Background

Nuclear transit studies (NTS) allow us to follow transit through the stomach and the small and large intestines. We identified children with chronic constipation with rapid proximal colonic transit and characterized their clinical features.

Methods

We reviewed NTS from 1998 to 2009 to identify patients with chronic constipation and rapid proximal colonic transit, defined as greater than 25% of tracer beyond hepatic flexure at 6 hour and/or greater than 25% of tracer beyond end of descending colon at 24 hour. This was correlated with clinical symptoms and outcome from patient records.

Results

Five hundred twenty children with chronic constipation underwent investigation by NTS, and 64 (12%) were identified with rapid proximal colonic transit. The clinical history, symptoms, and outcome in 55 of 64 available for analysis frequently showed family history of allergy (10.9%) and symptoms associated with food allergy/intolerance: abdominal pain (80%), anal fissure (27.3%), and other allergic symptoms (43.6%). Eighteen children were treated with dietary exclusion, with resolution of symptoms in 9 (50%).

Conclusions

Some children with intractable chronic constipation have rapid proximal colonic transit, have symptoms consistent with possible food allergy/intolerance, and may respond to dietary exclusion. The NTS can identify these patients with rapid proximal transit that may be secondary to food intolerance.     

Targeting Risk Factors for Impaired Wound Healing and Wound Complications After Kidney Transplantation

Background

Because of potent immunosuppression, impaired wound healing and complications are frequent features after kidney transplantation (KTx).

Objective

To investigate the incidence and nature of impaired wound healing and complications at a single transplantation center in Norway.

Patients

Of 226 patients who underwent KTx, 199 (87%) were followed up prospectively for 1 year (2005) via close and meticulous wound inspection.

Results

The study revealed a high rate of wound complications (200-250/y) in a high-volume center. Fifty-four patients (27%) experienced prolonged wound healing, defined as gaps, secretions, or wound complications, at 3 to 5 weeks posttransplantation, and 41 patients (21%) had impaired wound healing, defined as gaps, secretions, or wound complications after 5 weeks posttransplantation. In total, 50 patients (25%) required surgical or radiologic reintervention. Complications included lymphocele in 29 patients (14.6%), wound dehiscence in 16 (8.0%), bleeding or hematoma in 10 (5.0%), and infection in 9 (4.5%). Risk factors associated with wound complications included recipient older than 60 years, body mass index greater than 30, hemoglobin concentration less than 10 g/dL, albumin concentration less than 36 g/dL, duration of surgery more than 200 minutes, no subcutaneous sutures, and sirolimus or everolimus therapy. At nominal and logistic regression analysis, recipient older than 60 years, body mass index greater than 30, and no subcutaneous sutures were independent risk factors.

Conclusion

Risk factor analysis and previous documentation suggest that wound complications might be counteracted using the following measures: subcutaneous sutures, predialysis transplantation, sealing or ligation of lymphatic trunks, prophylactic fenestration, reduction of corticosteroid load, and avoiding sirolimus/everolimus therapy.     

Lower limb malrotation following MIPO technique of distal femoral and proximal tibial fractures

Objective

To determine the incidence of rotational malalignment in distal femoral and proximal tibial fractures using computed tomography (CT) scanograms following indirect reduction and internal fixation with the minimally invasive percutaneous osteosynthesis (MIPO) technique.

Design

Prospective Cohort.

Setting

Level I Trauma Centre.

Patients/Participants

A total of 27 consecutive subjects, and 14 proximal tibia and distal femur fractures.

Intervention

All patients underwent indirect reduction and internal fixation with a MIPO plating system. A CT scanogram to measure rotational malalignment between the injured and non-injured extremity was then undertaken.

Main outcome measure(s)

Femoral anteversion angles and tibial rotation angles between the injured and non-injured extremities were compared. Malrotation was defined as a side-to-side difference of >10°.

Results

A total of 14 postoperative tibias and 13 femurs underwent CT scanograms. Three females and 11 males with an average age of 38.1 years sustained proximal tibia fractures and six females and seven males with an average age of 55.8 years sustained distal femur fractures. The difference between tibial rotation in the injured and the non-injured limbs ranged from 2.7 to 40.0° with a mean difference of 16.2° (p = 0.656, paired T-test). Fifty percent of the tibias fixed with MIPO plates were malrotated >10° from the uninjured limbs. The difference between femoral anteversion in the injured and non-injured limbs ranged from 2.0 to 31.3° with a mean difference of 11.5° (p = 0.005, paired T-test). A total of 38.5% of the distal femurs fixed with MIPO plates were malrotated >10° from the uninjured limb.

Conclusions

Following fixation of distal femoral and proximal tibial fractures, the incidence of malrotation was 38.5% and 50%, respectively. The difference of the mean measures was significant for femoral malrotation; however, statistical significance could not be demonstrated for tibial malrotation. The incidence of malrotation following MIPO plating in this study is much higher than that quoted in previous studies.     

The evaluation of morbidity and mortality in abdominal aortic aneurysm repair patients as related to body mass index

Background

This study evaluates the relationship between body mass index (BMI) and other comorbidities on the overall morbidity and mortality of abdominal aortic aneurysm (AAA) repair.

Methods

A database of all nonemergent open and endovascular AAA repairs performed at our center from 2004 to 2008 was created. The outcomes at the predefined time intervals were then evaluated for each group of patients.

Results

One hundred forty-three patients qualified for this study with a 3:2 stent graft-to-open ratio. A trend relating patient BMI with early mortality was noted. Age >80 years was a strong predictor of mortality in all time intervals.

Conclusions

The outcomes for this population show a significant trend toward early mortality in open AAA repair patients with an elevated preoperative BMI. Appropriate patient selection and preoperative optimization are recommended for all AAA repair candidates; however, some innate characteristics such as patient age, may play the largest role in determining outcomes.     

Effects of rikkunshito,a kampo medicine,on quality of life after proximal gastrectomy

Background

The loss of the gastroesophageal junction after proximal gastrectomy (PG) induces various gastrointestinal symptoms, such as regurgitation, anorexia, and body weight loss, leading to impairment of the postoperative quality of life. In the present study, we investigated the long-term quality of life and the effects of rikkunshito, a traditional Japanese medicine (kampo), on the gastrointestinal symptoms and plasma ghrelin levels in patients with gastric cancer who had undergone PG.

Methods

Nineteen patients who had undergone PG> 6 mo before entry into the present study were enrolled. The plasma ghrelin levels, body weight, appetite, and Gastrointestinal Symptom Rating Scale (GSRS) scores were examined before and after the 4-wk administration of rikkunshito. A subgroup analysis was performed of patients showing a GSRS score of ≥ 2 before treatment, indicating the presence of gastrointestinal symptoms.

Results

The patients' body weight increased significantly after the administration of rikkunshito. Neither their appetite nor plasma acylated and deacylated ghrelin levels were significantly affected. In the subgroup analysis, the mean total GSRS score improved significantly from 2.6 ± 0.6 before the administration of rikkunshito to 1.9 ± 0.7 after administration because of the significant improvement in the subscale scores for abdominal pain, acid reflux, diarrhea, and constipation.

Conclusions

The long-term quality of life was well preserved in the patients who had undergone PG at our hospital. In the patients with a baseline GSRS score of ≥2, rikkunshito significantly improved the symptoms of postgastrectomy syndrome, and its effect was possibly independent of the plasma ghrelin levels.     

保留幽门回盲肠代胃在近端胃癌根治术中的应用

目的:为减少近端胃癌根治术后返流性食管炎的发生及增加胃切除术后的残胃容量,提高胃癌术后的总体生存质量。方法:在近端胃癌根治术后,将带血供的回盲肠移植于残胃与食道之间,结果:14例中,术后第10天恢复正常饮食的11例;食道回肠吻合口漏及狭窄各1例;死亡1例。生存的13例中随诊6～12个月,均无返流性食道炎症状,恢复术前饮食量。结论:保留幽门回盲肠代胃可有效防止近端胃癌根治术后的反流性食道炎及增加饮食量,提高生存质量。     

Effects of orthotopic liver transplantation in inbred rats on bone biomechanical properties

Aim

To determine the effects of orthotopic liver transplantation in inbred rats on the mechanical properties of bones at different anatomic sites.

Methods

The 24 rats that survived liver transplantation were paired with sham-operated rats of similar body weight. Six months after surgery, the lumbar vertebra, the proximal femur, and the middle femoral shaft were measured for their biomechanical properties and bone mineral density.

Results

The ultimate force, the ultimate stress, the Young modulus and the bone mineral density of both the proximal femur and the middle femur shaft of the rats were significantly reduced in the liver transplant group. However, no significant change was observed in the various parameters that indicate the biomechanical properties and the bone mineral density of the lumbar vertebra.

Conclusions

Orthotopic liver transplantation impairs the biomechanical properties of the proximal femur and the middle femoral shaft. Orthotopic liver transplantation itself is one of the risk factors for posttransplant fracture.     

A serum factor(s) after small bowel resection induces intestinal epithelial cell proliferation: effects of timing,site, and extent of resection

Background/purpose

After small bowel resection (SBR), serum induces proliferation in rat intestinal epithelial cells (RIEC-6). This study was designed to elucidate the effects of postoperative time interval, site, and magnitude of SBR on RIEC-6 proliferation.

Methods

Serum was collected from rats at various times after a 75% mid-SBR or sham operation and added to RIEC-6 cells and growth determined over 5 days. In other experiments, cell growth was recorded in the presence of serum from rats after 25%, 50%, or 75% SBR, or after jejunal or ileal SBR.

Results

SBR serum enhanced RIEC-6 cell proliferation as early as 12 hours after resection. The extent of SBR directly correlated with the level of adaptation; however, the effects on cell growth by the serum were similar. SBR serum induced proliferation equally after either proximal or distal resection.

Conclusions

Serum contains a factor that stimulates intestinal cell proliferation soon after SBR but independent of the degree or site of intestinal resection. Although humoral factor(s) play a role in the early induction of enterocyte proliferation after SBR, further modulation of adaptation to varied lengths or sites of intestinal resection are probably governed by mechanisms independent of factors that circulate in the serum.     

Esophagogastrostomy Plus Gastrojejunostomy: A Novel Reconstruction Procedure after Curative Resection for Proximal Gastric Cancer

Objective

The choice of surgical strategy for patients with proximal gastric cancer remains controversial. In this study, we recommend that a new reconstruction procedure be performed following proximal gastrectomy.

Methods

We conducted a retrospective study involving 71 patients who underwent gastrectomy for proximal gastric cancer. Clinicopathological features, postoperative complications, nutritional status, and overall survival (OS) rate were compared among three different reconstruction approaches.

Results

There were 34 cases of proximal gastrectomy followed by esophagogastrostomy reconstruction (EG), 16 cases of total gastrectomy and Roux-en Y reconstruction (RY) and 21 cases of proximal gastrectomy followed by esophagogastrostomy plus gastrojejunostomy reconstruction (EGJ). Though the clinicopathological features, the nutritional status and OS rate were similar among the three groups of patients, the incidence of reflux esophagitis was significantly higher in the EG group (35.3 %) than the RY (6.2 %) and EGJ (9.6 %) groups(P?<?0.05). Few EGJ patients suffered from either reflux esophagitis or anastomotic stenosis.

Conclusions

The EGJ reconstruction method helps to resolve the syndrome of reflux esophagitis. Our data indicates that it is a simple, safe, and effective reconstruction procedure for PGC.     

Surgical outcomes and survival after multiorgan resection for locally advanced gastric cancer

Background

Multiple organ resection for locally advanced (assumed T4) gastric cancer is associated with high morbidity and mortality. Our aim was to evaluate the efficacy of these surgeries with regard to surgical morbidity, mortality, and survival.

Methods

Fifty-six patients underwent potentially radical gastrectomy combined with invaded organ resection. Early and late results of multiorgan resection and clinicopathologic factors influencing these results were evaluated.

Results

Forty patients (71.4%) received 1 additional organ resection and 16 patients (28.6%) received 2 or more additional organ resections. Postoperative morbidity and mortality was 37.5% and 12.5%, respectively. Resection of 2 or more additional organs increased postoperative morbidity and advanced age increased mortality. The 1- and 3-year survival rates were 53.3% and 28.1%, respectively. Advanced age, lymph node metastasis, and resection of more than 1 additional organ were significant prognostic factors for survival.

Conclusions

For patients with locally advanced gastric carcinoma, multiple organ resection is worthwhile with careful patient selection.     

Quality-of-life outcomes after surgical correction of pectus excavatum: a comparison of the Ravitch and Nuss procedures

Purpose

The purpose of this study was to compare clinical and health-related quality-of-life (HRQL) outcomes within a group of patients treated for pectus excavatum (PE).

Methods

A retrospective 3-year review of patients undergoing Nuss or Ravitch correction of PE was performed. Health-related quality-of-life assessment was performed using the Child Health Questionnaire (CHQ-CF87) and the 17-item Pectus Excavatum Evaluation Questionnaire, and results were compared between groups and with age-matched CHQ-CF87 normative data.

Results

Forty-three patients (39 males; 91%) underwent surgery; 19 (44%) by Nuss procedure. Duration of postoperative opioid analgesia and length of hospital stay (LOS) were significantly longer in Nuss patients. The overall survey response rate was 53%. The groups differed significantly in the CHQ on one item (Change in Health). On the Pectus Excavatum Evaluation Questionnaire, Nuss patients reported being “less bothered” by the appearance of their chest. Compared to Australian age-matched norms, the aggregate PE sample showed better scores for family activity domain and worse scores in mental health, general health perceptions, change in health, bodily pain, and self-esteem.

Conclusions

Patients undergoing surgery for PE by either Nuss or Ravitch procedure have similar clinical and HRQL outcomes, but as a group have poorer HRQL scores than age-matched population norms.     

Esophagogastric tube reconstruction with stapled pseudo-fornix in laparoscopic proximal gastrectomy: a novel technique proposed for Siewert type II tumors

Purpose

The incidence of adenocarcinoma of the esophagogastric junction is increasing, but laparoscopic proximal gastrectomy is not widely accepted due to the absence of a standardized technique of reconstruction. This report describes a novel technique of esophagogastric tube reconstruction in laparoscopic proximal gastrectomy for Siewert type II tumors.

Methods

Laparoscopic proximal gastrectomy, sometimes with transhiatal distal esophagectomy, was performed. After a perigastric, suprapancreatic, and lower thoracic paraesophageal lymphadenectomy, a gastric tube of 35-mm width was prepared. An esophagogastric tube anastomosis with pseudo-fornix was made with a no-knife linear stapler to prevent postoperative reflux esophagitis.

Results

Fifteen patients with Siewert type II tumors underwent this operation. They included six patients with early-stage cancer, six at high risk for transhiatal total gastrectomy due to several comorbidities, and three who needed palliative tumor resection. The mean operation time was 315 min. One postoperative anastomotic leak was treated conservatively, and three anastomotic stenoses were resolved with endoscopic balloon dilatation. Postoperative 1-year follow-up endoscopy revealed four cases of reflux esophagitis that were well controlled by medication.

Conclusions

This new technique of reconstruction was feasible. With the advantage of a gastric tube, a tension-free anastomosis was possible even for bulky tumors that needed lower esophagectomy. Although long-term follow-up and a larger number of patients are required to evaluate long-term functional outcomes and oncological adequacy, our procedure has the potential of becoming a treatment of choice for early-stage Siewert type II tumors and/or for some selected high-risk patients who need tumor resection.     

Projected incidence of proximal femoral fracture in England: a report from the NHS Hip Fracture Anaesthesia Network (HIPFAN)

Aims

This study was designed to estimate trends in the number of proximal femoral fractures (PFFs), and consequent bed day requirements and financial implications for England until 2033.

Methods

Trends in the number of coded PFFs from 1998 to 2008 (collected from Hospital Episode Statistics Online) were projected forward to 2033, and modified according to published data concerning population demographics and declining PFF prevalence. Estimates of 30 day postoperative mortality were calculated according to projected demographic data. Financial estimates were calculated according to current cost and adjusted according to projected inflation.

Results

Despite a decline in the prevalence of PFF among the aging population (2.98% since 2002), we estimate that approximately 100,000 patients annually will require surgery for fractured neck of femur by 2033 in England, with a 30d mortality of 8.9-9.3%, costing £3.6-5.6 billion (inflation adjusted) in total care.

Conclusions

The evaluation and implementation of cost-effective preventive and therapeutic strategies in the short term may help to ameliorate the future financial burden of PFF, and, more importantly, improve the outcome and quality of life for the elderly after fracture.     

两种胃切除术式对进展期近端胃癌预后的影响分析

目的比较全胃切除和近端胃切除对进展期近端胃癌预后的影响。 方法回顾分析2008年1月至2012年3月就诊的172例进展期近端胃癌患者的临床病理资料,按不同的手术方式分为近端胃切除组(83例)和全胃切除组(89例);观察并记录患者手术情况、术后并发症等情况,并对患者出院后生存、肿瘤复发、转移等情况进行为期5年的随访。采用SPSS 24.0统计软件进行数据分析,年龄、手术时间、术中出血量等计量资料采用( ±s)表示,比较采用独立t检验;性别、肿瘤部位等无序二分类资料采用卡方检验,肿瘤大小浸润深度等有序二分类资料采用秩和检验;生存分析采用Kaplan－Meier法,以P<0.05为差异有统计学意义。 结果全胃切除组患者手术时间、术中出血量较近端胃切除组患者偏高,其余术中及术后情况差异无统计学意义。全胃切除组患者术后胃排空障碍、吻合漏和反流性食管炎的发生率较近端切除组患者显著偏低(P<0.05)。术后1年、3年、5年生存率,近端切除组患者分别为71.1%、45.5%和34.2%明显低于全胃切除组83.1%、67.2%和56.6%;(F＝10.746, P＝0.001)。 结论全胃切除能减少对进展期近端胃癌术后并发症的发生率,并延长患者术后生存时间。