切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2018, Vol. 12 ›› Issue (02) : 130 -132. doi: 10.3877/cma.j.issn.1674-3946.2018.02.013

所属专题: 文献

论著

两种胃切除术式对进展期近端胃癌预后的影响分析
马永恩1,(), 李建平1   
  1. 1. 637400 四川,阆中市人民医院胃肠外科
  • 收稿日期:2017-07-07 出版日期:2018-02-26
  • 通信作者: 马永恩

Prognostic analysis of two types of gastrectomy for advanced proximal gastric cancer

Yongen Ma1,(), Jianping Li1   

  1. 1. Department of Gastrointestinal Surgery, Langzhong People's Hospital, Langzhong Sichuan 637400, China
  • Received:2017-07-07 Published:2018-02-26
  • Corresponding author: Yongen Ma
  • About author:
    Corresponding author: Ma Yongen, Email:
引用本文:

马永恩, 李建平. 两种胃切除术式对进展期近端胃癌预后的影响分析[J/OL]. 中华普外科手术学杂志(电子版), 2018, 12(02): 130-132.

Yongen Ma, Jianping Li. Prognostic analysis of two types of gastrectomy for advanced proximal gastric cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2018, 12(02): 130-132.

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KaplanMeier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。

Objective

To compare the clinical outcome of total gastrectomy and proximal gastrectomy for advanced proximal gastric cancer.

Methods

From January 2008 to March 2012, clinical data of 172 patients with advanced proximal gastric cancer in our hospital were analyzed retrospectively. According to operation methods, 172 patients were divided into proximal gastrectomy group (83 cases) and total gastrectomy group (89 cases). The operation data and complications of the patients were observed and recorded, and the survival, recurrence and metastasis of the patients were followed up for 5 years. SPSS24.0 statistical software was used for data analysis, Measurement data such as age, time of operation and amount of bleeding during operation were presented as (±s) and were examined by t test. Gender, tumor location and other disorder two classification data were examined by using chi square test, Tumor size, depth of infiltration and other ordered two categorical data were examined by rank sum test; Kaplan-Meier method was used by survival analysis. P<0.05 was thought to be statistically significant.

Results

The operation time and the amount of bleeding of patients underwent total gastrectomy were more than those of patients underwent proximal gastrectomy (P<0.05). However, there was no significant difference between 2 groups in terms of other intraoperative and postoperative indicators. Compared with proximal gastrectomy, patients received total gastrectomy had significantly lower incidence of complications such as gastric emptying dysfunction, leakage and reflux esophagitis (P<0.05). 1 year , 3 year and 5 year survival in proximal resection group were 71.1%, 45.5% and 34.2%, respectively, which were significantly lower than 83.1%, 67.2% and 56.6% in total gastrectomy group (F=10.746, P=0.001).

Conclusion

Total gastrectomy could reduce the incidence of postoperative complications, and prolong the postoperative survival.

表1 172例进展期近端胃癌患者不同术式两组患者的一般资料比较(例)
表2 172例进展期近端胃癌患者不同术式两组患者术中及术后情况比较(±s)
表3 172例进展期近端胃癌患者不同术式两组患者的并发症情况比较(例)
图1 172例进展期近端胃癌患者不同术式两组患者术后5年随访及生存情况
[1]
万德森. 临床肿瘤学[M]. 科学出版社,第四版2015,1:213-221.
[2]
许可葵,史百高,廖先珍,等. 湖南省肿瘤登记地区2009~2012年恶性肿瘤发病及死亡资料分析[J]. 中国肿瘤,2016, 25(4):241-250.
[3]
伊丽,马恒敏,李琰琰,等. 2000-2012年肥城市农村居民恶性肿瘤发病趋势分析[J]. 中华肿瘤防治杂志,2015, 22(24):1861-1864.
[4]
Sano T, Aiko T. New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points[J]. Gastric Cancer, 2011, 14(2):97-100.
[5]
Takiguchi N, Takahashi M, Ikeda M, et al. Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by postgastrectomy syndrome assessment scale (PGSAS-45): a nationwide multi-institutional study[J]. Gastric Cancer, 2015, 18(2):407-416.
[6]
Jung DH, Ahn SH, Park DJ, et al. Proximal Gastrectomy for Gastric Cancer[J]. Journal of Gastric Cancer, 2015, 15(2):77-86.
[7]
Association JGC. Japanese gastric cancer treatment guidelines 2014 (ver. 4)[J]. Gastric Cancer, 2017,20(1):1-19.
[8]
Sugoor P, Shah S, Dusane R, et al. Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary[J]. Langenbecks Archives of Surgery, 2016, 401(5):687-697.
[9]
Huh YJ, Lee HJ, Oh SY, et al. Clinical Outcome of Modified Laparoscopy-Assisted Proximal Gastrectomy Compared to Conventional Proximal Gastrectomy or Total Gastrectomy for Upper-Third Early Gastric Cancer with Special References to Postoperative Reflux Esophagitis[J]. Journal of Gastric Cancer, 2015, 15(3):191-200.
[10]
卢昕,孟庆彬,邵永胜. 进展期近端胃癌近端胃与全胃切除的对比研究[J]. 中华普通外科杂志,2016, 31(2):97-99.
[11]
Kosuga T, Ichikawa D, Komatsu S, et al. Feasibility and Nutritional Benefits of Laparoscopic Proximal Gastrectomy for Early Gastric Cancer in the Upper Stomach[J]. Annals of Surgical Oncology, 2015, 22(Suppl 3):S929-935.
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[3] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[4] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[5] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[6] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[7] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[8] 韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[9] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[10] 陈浩, 王萌. 胃印戒细胞癌的临床病理特征及治疗选择的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 108-111.
[11] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[12] 孟令凯, 李大勇, 王宁, 王桂明, 张炳南, 李若彤, 潘立峰. 袖状胃切除术对肥胖伴2型糖尿病大鼠的作用及机制研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 638-642.
[13] 刘海旺, 施海, 尚利峰. 不同吻合器在腹腔镜远端胃癌根治术Roux-en-Y式吻合中的应用对比[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 643-646.
[14] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[15] 刘见, 杨晓波, 何均健, 等. 应用电钩三孔法腹腔镜袖状胃切除术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(06): 363-364.
阅读次数
全文


摘要