摘要目的 评价SiewertⅡ～Ⅲ型食管胃结合部腺癌近端胃切除背驮式间置空肠吻合术中两种消化道重建方式的临床疗效.方法 按照入组排除标准前瞻性收集2015年10月至2017年8月于山西省肿瘤医院微创消化外科确诊为SiewertⅡ～Ⅲ型食管胃结合部腺癌并接受近端胃切除间置空肠吻合的84例患者,男性61例,女性23例,年龄48～69岁,平均年龄59.7岁.按照随机数字表法分为单通道组41例与双通道组43例.两组均行近端胃切除间置空肠吻合,单通道组术中将残胃与空肠侧侧吻合后,结扎或闭合该吻合口下方3 cm处的空肠,双通道组术中不处理此段肠管.收集术后3个月及6个月相关营养指标的结果.使用重复测量方差分析的方法分析数据结果,明确术后营养状况.结果 两组术前一般情况比较差异无统计学意义(P＞0.05),围手术期相关指标差异无统计学意义(P＞0.05).营养学指标方面,单通道组血红蛋白(F=23.374,P=0.000)、清蛋白(F=6.149,P=0.003)、总蛋白(F=18.362,P=0.000)、体重(F=74.255,P=0.000)均高于双通道组.术后6个月生活质量比较,两组患者反流、烧心、恶心呕吐、吞咽困难、胸骨后不适等主观症状的发生率,以及QLQ-STO22评分差异无统计学意义(27.0±3.8比27.6±3.3,t=-0.688,P=0.494);胃镜检查结果显示,反流性食管炎发生率(2/41比2/43,P=1)和反流程度(Z=-1.528,P=0.127)两组差异无统计学意义.结论 接受近端胃切除背驮式间置空肠手术的SiewertⅡ～Ⅲ型食管胃结合部腺癌患者,在术中进行单通道消化道重建可取得较理想的治疗效果.

abstractsObjective To evaluate the clinical efficacy of two different digestive tract reconstruction methods in the Siewert Ⅱ or Ⅲ adenocarcinoma of esophagogastric junction underwent proximal gastrectomy and piggyback jejunal interposition.Methods A total of 84 patients with Siewert Ⅱ or Ⅲ AEG who underwent proximal gastrectomy and interposition jejunal anastomosis were enrolled prospectively according to the exclusion criteria,from October 2015 to August 2017 at Department of Digestive Minimally Invasive Surgery,Shanxi Cancer Hospital.There were 61 male and 23 female patients,aged 48-69 years with an average age of 59.7 years.They were divided into single-tract reconstruction group (n=41) and double-tract reconstruction group (n=43) according to random number table.Both groups underwent proximal gastrectomy and piggyback jejunal interposition.After side-to-side anastomosis of the remnant stomach and jejunum was performed in the single-tract group,jejunum 3 cm below the anastomosis was ligated or closed.The jejunum in the double-tract group was not treated during the operation.Relevant nutritional indicators were collected at 3 months and 6 months after operation.The data were analyzed by repeated measurement of variance analysis to determine the nutritional status.Results There was no significant difference in preoperative general condition between single-tract reconstruction group and double-tract reconstruction group (P＞0.05).There was no significant difference in perioperative related indicators (P＞0.05).Nutritional indicators in single-channel reconstruction group were higher than those in double-channel reconstruction group (hemoglobin:F=23.374,P=0.000;albumin:F=6.149,P=0.003;total protein:F=18.362,P=0.000;weight:F=74.255,P=0.000).The quality of life was compared half year after operation,there was no significant difference in the incidence of subjective symptoms such as reflux,heart burning,nausea and vomiting,dysphagia and sternum discomfort in the two groups (P＞0.05),as well as the results of QLQ-STO22 score (27.0±3.8 vs.27.6±3.3,t=-0.688,P=0.494).The results of gastroscopy showed that the incidence and degree of the two groups were almost the same whether in the incidence of reflux esophagitis (2/41 vs.2/43,P=1) or in the contrast of reflux degree (Z=-1.528,P=0.127).Conclusion For patients with type Siewert Ⅱ or Ⅲ esophagogastric junction adenocarcinoma who underwent proximal gastrectomy and piggyback jejunal operation,single tract reconstruction is ideal.