根治性全胃切除与近端胃切除术治疗近端进展期胃癌的临床效果比较
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摘要
目的探讨根治性全胃切除术和近端胃切除术治疗近端进展期胃癌的临床效果。方法选择行手术切除的68例近端进展期胃癌患者作为研究对象,根据手术方式不同分为2组,其中A组接受根治性全胃切除术,B组接受近端胃切除术。随访36个月,收集并比较2组患者的近远期疗效、生活质量(QLQ-C30量表评估)及生存期。结果 A组手术时间及术中出血量明显高于B组,且差异具有统计学意义(P <0. 05),但术后早期并发症却无明显差别(P>0. 05); 2组患者远期并发症总发生率无明显差别(P> 0. 05),但在碱性反流性胃炎及倾倒综合征上差别明显(P <0. 05)。A组3年生存率(72. 14%)高于B组(43. 63%),差异具有统计学意义(P <0. 05)。与B组比较,A组整体健康及生活质量量表评分和功能量表评分相对升高,而症状量表评分和单项测量项目评分相对较低,且组间差异均具有统计学意义(P <0. 05)。结论与近端胃切除术相比,根治性全胃切除术可提高近端进展期胃癌患者的远期疗效,改善生活质量,延长生存期。
Objective To explore the effect of radical gastrectomy and proximal gastrectomy on postoperative tumor in patients with near advanced gastric cancer. Methods 68 patients with advanced gastric cancer resection were selected,they were divided into 2 groups according to different surgical methods,A group was 43 cases which were given radical gastrectomy; B group was 25 cases which were given proximal gastrectomy. After follow-up for 36 months,the short-term and long-term effects,quality of life( QLQ-C30 scale assessment) and survival time were collected and compared between the 2 groups. Results The operation time and the amount of bleeding during operation in group A were significantly higher than those of group B,and the difference was statistically significant( P < 0. 05),but there was no significant difference in the early postoperative complications( P >0. 05); there was no significant difference in the total incidence of long-term complications between the 2 groups( P > 0. 05),but there was significant difference between the alkaline reflux gastritis and the dumping syndrome( P < 0. 05); 3-year survival rate of group A( 72. 14%) was higher than that of group B( 43. 63%),and the difference between the 2 groups was statistically significant( P < 0. 05); compared with B group,the overall health and quality of life score and function score in group A increased relatively,and the symptom scale and single measurement score in group A relatively decreased,and the differences were statistically significant( P < 0. 05). Conclusion Compared with the proximal gastrectomy,the radical total gastrectomy can improve long-term outcomes,improve quality of life and prolong survival of patients with near advanced gastric cancer.
Objective To explore the effect of radical gastrectomy and proximal gastrectomy on postoperative tumor in patients with near advanced gastric cancer. Methods 68 patients with advanced gastric cancer resection were selected,they were divided into 2 groups according to different surgical methods,A group was 43 cases which were given radical gastrectomy; B group was 25 cases which were given proximal gastrectomy. After follow-up for 36 months,the short-term and long-term effects,quality of life( QLQ-C30 scale assessment) and survival time were collected and compared between the 2 groups. Results The operation time and the amount of bleeding during operation in group A were significantly higher than those of group B,and the difference was statistically significant( P < 0. 05),but there was no significant difference in the early postoperative complications( P >0. 05); there was no significant difference in the total incidence of long-term complications between the 2 groups( P > 0. 05),but there was significant difference between the alkaline reflux gastritis and the dumping syndrome( P < 0. 05); 3-year survival rate of group A( 72. 14%) was higher than that of group B( 43. 63%),and the difference between the 2 groups was statistically significant( P < 0. 05); compared with B group,the overall health and quality of life score and function score in group A increased relatively,and the symptom scale and single measurement score in group A relatively decreased,and the differences were statistically significant( P < 0. 05). Conclusion Compared with the proximal gastrectomy,the radical total gastrectomy can improve long-term outcomes,improve quality of life and prolong survival of patients with near advanced gastric cancer.
引文
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[9]曾长青,黄良祥,陈林昊,等.近端胃癌根治术后三种消化道重建方式近期及远期疗效的比较[J].中华胃肠外科杂志,2014,17(5):444-448.
[10]Isobe T,Hashimoto K,Kizaki J,et al.Reconstruction methods and complications in proximal gastrectomy for gastric cancer,and a comparison with total gastrectomy[J].Kurume Med J,2014;61(2):23-29.
[11]李茂然,朱纯超,赵刚,等.功能性保护腹腔镜辅助根治性近端胃切除术在早期胃癌治疗中的应用[J].中华胃肠外科杂志,2016,19(2):190-194.
[12]卢昕,孟庆彬,邵永胜,等.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.
[13]胡建,周阮萍,陈梦婷,等.近端胃癌的全胃切除术与近端胃切除术术后5年生存率Meta分析[J].南昌大学学报(医学版),2016,56(4):43-47.
[2]邹小农,孙喜斌,陈万青,等.2003-2007年中国胃癌发病与死亡情况分析[J].肿瘤,2012,32(2):109-114.
[3]吕潇童.进展期胃癌的治疗进展[J].医学综述,2013,19(19):3513-3515.
[4]张永康.局部进展期胃癌的治疗进展[J].安徽医科大学学报,2013,48(8):992-994.
[5]Fein M,Fuchs KH,Thalheimer A,et al.Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy:a randomized trial[J].Ann Surg,2015,247(5):759-765.
[6]Masuzawa T,Takiguchi S,Hirao M,et al.Comparison of perioperative and long-term outcomes of total and proximalgastrectomy for early gastric cancer:a multi-institutional retrospective study[J].World J Surg,2014,38(5):1100-1106.
[7]李丽梅,李赓,吴晓东,等.多学科联合干预治疗模式对晚期癌症患者生活质量的研究[J].中华保健医学杂志,2014,16(3):174-176.
[8]杨宏,武爱文,季加孚,等.近端胃癌和远端胃癌分子生物学特点比较[J].中华外科杂志,2012,47(23):1821-1823.
[9]曾长青,黄良祥,陈林昊,等.近端胃癌根治术后三种消化道重建方式近期及远期疗效的比较[J].中华胃肠外科杂志,2014,17(5):444-448.
[10]Isobe T,Hashimoto K,Kizaki J,et al.Reconstruction methods and complications in proximal gastrectomy for gastric cancer,and a comparison with total gastrectomy[J].Kurume Med J,2014;61(2):23-29.
[11]李茂然,朱纯超,赵刚,等.功能性保护腹腔镜辅助根治性近端胃切除术在早期胃癌治疗中的应用[J].中华胃肠外科杂志,2016,19(2):190-194.
[12]卢昕,孟庆彬,邵永胜,等.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.
[13]胡建,周阮萍,陈梦婷,等.近端胃癌的全胃切除术与近端胃切除术术后5年生存率Meta分析[J].南昌大学学报(医学版),2016,56(4):43-47.