标题：不同手术入路治疗食管胃结合部腺癌对患者近期安全性与远期生存期的影响

      作者：吴飞马 1，李艳星 1，赵玉明 1，朱晓峰 1，李振华 1，李文芳 2    (1.咸宁市中心医院(湖北科技学院附属第一医院)心胸外科，湖北 咸宁 437100；2.湖北医药学院附属十堰市人民医院儿科，湖北 十堰 442000)

      卷次： 2017年28卷18期

      【摘要】 目的 探讨不同手术入路治疗食管胃结合部腺癌(AEG)患者对于近期安全性与远期生存期的影响。方法 选择2013年1月到2016年2月咸宁市中心医院(湖北科技学院附属第一医院)收治的120例食管胃结合部腺癌患者作为研究对象，根据随机数表法分为观察组与对照组各60例，对照组采用经胸手术治疗，观察组采用经腹手术治疗，记录两组近远期预后情况。结果 所有患者都顺利完成手术，术中无严重并发症发生，两组手术时间、术中出血量比较差异无统计学意义(P>0.05)；观察组患者的术后住院时间、清扫淋巴结个数明显优于对照组，差异均有统计学意义(P<0.05)；观察组患者术后1个月的并发症发生率为8.3%，低于对照组的23.3%，差异有统计学意义(P<0.05)；观察组患者术后1个月的日常生活、一般状况、社会影响、情感活动、治疗相关症状等生活质量评分均明显高于对照组，差异有统计学意义(P<0.05)；随访到 2017年 1月，观察组的中位生存时间为(22.94±3.22)个月，1年生存率为98.3%，均明显长于或高于对照组的(18.34±3.09)个月和 85.0%，差异均有统计学意义(P<0.05)。结论 经腹手术治疗食管胃结合部腺癌能减少近期并发症的发生，提高生活质量，延长患者的远期生存时间。
      【关键词】 手术入路；食管胃结合部腺癌；并发症；生存期；经腹手术
      【中图分类号】 R735 【文献标识码】 A 【文章编号】 1003—6350（2017）18—2956—03

Effects of different surgical approaches on the safety and long-term survival of patients with adenocarcinoma ofesophagogastric junction.
WU Fei-ma 1, LI Yan-xing 1, ZHAO Yu-ming 1, ZHU Xiao-feng 1, LI Zhen-hua 1, LI Wen-fang 2.1. Department of Cardiothoracic Surgery, Xianning Central Hospital, the First Affiliated Hospital of Hubei University ofScience and Technology, Xianning 437100, Hubei, CHINA; 2. Department of Pediatrics, Renmin Hospital of Shiyan, theAffiliated Hospital of Hubei University of Medicine, Shiyan 442000, Hubei, CHINA
【Abstract】 Objective To investigate the effects of different surgical approaches on the safety and long-termsurvival of patients with adenocarcinoma of esophagogastric junction. Methods From January 2013 to February 2016,120 patients with adenocarcinoma of the esophagogastric junction were selected from the First Affiliated Hospital of Hu-bei University of Science and Technology. These patients were divided into the observation group and the control groupaccording to random number table, with 60 cases in each group. The control group was treated by thoracic surgery, andthe observation group was treated by abdominal surgery. The short-term and long-term prognosis of the two groups wererecorded. Results All patients successfully completed surgery and no serious complications occurred during the opera-tion. There was no significant difference in the operation time and bleeding volume between the two groups (P>0.05);and the lymph node dissection number, time of hospitalization in the observation group were significantly better thanthose in the control group (P<0.05). The incidence of complications such as reflux esophagitis, pulmonary infection, inci-sion infection, anastomotic fistula, anastomotic bleeding and other complications one month after the operation was8.3%, which was significantly lower than 23.3% in the control group (P<0.05); the quality of life (QOL) of the observa-tion group was significantly higher than that of the control group (P<0.05). Up to now, the median survival time of theobservation group was (22.94±3.22) months and the one year survival rate of the patients was 98.3%, which were signifi-cantly higher than (22.94±3.22) months and 85.0% of the control group (P<0.05). Conclusion Transabdominal surgerycan reduce the occurrence of recent complications in the treatment of adenocarcinoma of esophagogastric junction, im-prove the quality of life, and prolong the long-term survival time of patients.
      【Key words】 Surgical approach; Adenocarcinoma of esophagogastric junction; Complications; Survival; Transab-dominal surgery·论 著·doi:10.3969/j.issn.1003-6350.2017.18.009