中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (02): 195-201.DOI: 10.19538/j.cjps.issn1005-2208.2025.02.12

• 论著 • 上一篇    下一篇

Siewert Ⅱ/Ⅲ型食管胃结合部腺癌行近端胃切除术SOFY重建与全胃切除术Roux-en-Y重建安全性、疗效及营养水平对比研究

张海翘，王    鈢，黄    勇，王子萌，李佳璇，薛雅圣，郑    智，刘小野，尹    杰，张    军   

  1. 首都医科大学附属北京友谊医院普外科，北京 100050
  • 出版日期:2025-02-01 发布日期:2025-02-26

  • Online:2025-02-01 Published:2025-02-26

摘要： 目的    探究Siewert Ⅱ/Ⅲ型食管胃结合部腺癌（AEG）行近端胃切除术（PG）SOFY重建对比全胃切除术（TG）Roux-en-Y重建的安全性、疗效及营养水平。方法    通过双向性队列研究分析2017年3月至2023年6月首都医科大学附属北京友谊医院诊治的154例Siewert Ⅱ/Ⅲ型AEG病人的病例资料，其中PG组66例，TG组88例，主要研究结局为病人术后1年的体重减少率。结果    PG组平均手术时长、术中出血量、术后首次排气时间和术后首次进流食时间均显著优于TG组，差异有统计学意义（P<0.05）。119例病人完成1年随访，其中PG组53例，TG组66例。PG组术后6个月（-10.6% vs. -14.0%）和1年（-9.0% vs. -15.2%）体重减少率小于TG组，差异有统计学意义（P<0.05）。PG组术后1年腹泻情况和进食受限程度优于TG组，TG组术后1年胃食管反流发生率（9.1% vs. 50.9%）、反流症状评分、整体健康状况方面优于PG组，差异有统计学意义（P<0.05）。PG组21例（39.6%）病人术后1年发生了反流性食管炎，根据洛杉矶分级（LA），LA-A级13例（61.9%），LA-B级6例（28.6%），LA-C级2例（9.5%），无LA-D级病例。结论    在Siewert Ⅱ/Ⅲ型AEG外科治疗中，PG（SOFY重建）在手术操作、围手术期恢复以及术后体重维持均较TG（Roux-en-Y重建）具有明显优势，而TG在术后生活质量具有明显优势。此外，SOFY重建后反流性食管炎的发生率较高，但多为LA-A级，标准剂量的质子泵抑制剂药物治疗可控制症状。

关键词: 食管胃结合部腺癌, 近端胃切除术, 全胃切除术, 消化道重建, 生活质量

Abstract: To compare the safety, efficacy and nutrition of proximal gastrectomy (PG) with SOFY versus total gastrectomy (TG) with Roux-en-Y for treating Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG). Methods    We used a bidirectional cohort study to analyze the clinical data of 154 Siewert Ⅱ/Ⅲ AEG patients treated at Beijing Friendship Hospital, Capital Medical University from March 2017 to June 2023. There were 66 cases in PG group and 88 cases in TG group. The main outcome was weight loss rate 1 year after surgery in both groups. Results    The PG group showed significant advantages over the TG group in average operative time, intraoperative blood loss, time to pass gas, and time to liquid intake, with statistically significant differences (P<0.05). Among the 119 cases that completed a one-year follow-up, there were 53 in the PG group and 66 in the TG group. The weight loss rates at 6 months (-10.6% vs. -14.0%) and at 1 year (-9.0% vs. -15.2%) were lower in the PG group compared to the TG group, with statistically significant differences (P<0.05). The PG group had better outcomes regarding diarrhea and the degree of eating restriction at 1 year after surgery compared to the TG group. However, the TG group had a lower incidence of gastroesophageal reflux (9.1% vs. 50.9%) , better reflux symptom scores, and better overall health status at 1 year after surgery than the PG group, with statistically significant differences (P<0.05). In the PG group, 21 patients (39.6%) developed reflux esophagitis at 1 year after surgery, classified according to the Los Angeles classification (LA), 13 cases at LA-A (61.9%), 6 cases at LA-B (28.6%), and 2 cases at LA-C (9.5%), with no cases at LA-D. Conclusion    In the surgical treatment of Siewert Ⅱ/Ⅲ AEG, PG (SOFY reconstruction) shows significant advantages over TG (Roux-en-Y reconstruction) in terms of surgical operation, perioperative recovery, and postoperative weight maintenance. However, TG has a notable advantage in postoperative quality of life. Additionally, the incidence of reflux esophagitis is higher after SOFY reconstruction, but most cases are classified as LA-A, and symptoms can be controlled with standard doses of PPI medication. 

Key words: adenocarcinoma of the esophagogastric junction, proximal gastrectomy, total gastrectomy, digestive tract reconstruction, quality of life