作　　者： (胡春华）; (李冬冬）; (徐义军）; (项洪刚）; (陈磊）; (张文杰）;

机构地区： 上海交通大学医学院附属新华医院普通外科,上海200092

出　　处： 《中国临床医学》 2017年第3期369-376,共8页

摘　　要： 目的:探讨影响SiewertⅡ/Ⅲ型食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)患者预后的临床病理因素,以及不同手术方式对患者生活质量的影响。方法:回顾性分析2004—2015年接受手术治疗的SiewertⅡ/Ⅲ型AEG患者的病例资料,并选择随访两年以上的AEG患者进行生存预后分析,比较Ⅱ/Ⅲ型AEG患者预后与临床病理之间的关系。采用问卷调查的方法评估全胃切除术(total gastrectomy,TG)或近端胃切除术(proximal gastrectomy,PG)完成1年后患者的生活质量。结果:共纳入325例AEG患者,其中Ⅱ型157例(48.3%),Ⅲ型168例(51.7%)。Ⅲ型AEG比Ⅱ型的肿瘤直径大、分化程度低、阳性淋巴结数目多、预后较差(均P<0.05)。单因素分析发现,肿瘤直径、分化程度、肿瘤部位、切除范围、R0切除、脉管浸润、神经浸润和TNM分期等影响Ⅱ/Ⅲ型患者的长期预后。相关性分析发现,淋巴结阳性浸润率与患者生存时间负相关(r=-0.520,P<0.001)。Ⅱ型AEG患者中,PG组与TG组患者术后5年生存率及生存时间差异均无统计学意义;而Ⅲ型AEG患者中,TG组患者术后5年生存率比PG组明显降低(P<0.05)。预后多因素分析发现,T/N分期是影响Ⅱ型AEG患者预后的危险因素,而TNM分期是影响Ⅲ型AEG患者长期生存的独立危险因素。另外,有55例患者完成问卷调查,PG组较TG组患者术后较多出现明显影响生活质量的食物反流症状(P<0.05),其他症状和功能领域差异则无统计学意义。结论:Ⅲ型AEG的肿瘤直径大,分化程度低,淋巴结浸润数目多,且预后较差,因此为保证R0切除和彻底清扫,可行TG为基础的胃癌根治术。而在Ⅱ型AEG中,PG与TG不影响患者的长期预后生存。 Objective：To analyze the clinicopathological factors affecting the prognosis of patients with Siewert typeⅡ/Ⅲ adenocarcinoma of esophagogastric junction （AEG）, and the effect of different surgical methods on the quality of life.Methods：The clinical records of patients who were diagnosed with SiewertⅡ/Ⅲ AEG and received surgery from 2004 to 2015 were retrospectively analyzed.The patients followed up for at least 2 years were selected to perform survival analysis.The relationship between clinical pathological factors and prognosis of patients with Siewert Ⅱ/Ⅲ AEG was compared.The status of health-related quality of life at least 1 year after proximal gastrectomy （PG） or total gastrectomy （TG） was evaluated by a questionnaire.Results：A total of 325 patients with AEG were enrolled, including 157 patients with typeⅡAEG （48.3%） and 168 with type Ⅲ AEG （51.7%）.The patients with type Ⅲ AEG were likely to have larger tumors, lower differentiation, more lymph node metastasis, and poorer prognosis （all P〈0.05）.The univariate analysis showed that tumor size, differentiation degree, tumor location, resection range, R0 resection, vessel and nerve invasive status, and TNM stage were the long-term prognostic factors in 284 patients who were followed up for at least 2 years.Correlation analysis showed that the positive rate of lymph node metastasis was negatively correlated with overall survival time （r=-0.520, P〈0.001）.In patients with typeⅡAEG, there was no significant difference in the 5-year survival rate and survival time between the PG group and the TG group （P〉0.05）.In patients with type Ⅲ AEG, the 5 year survival rate of the TG group was significantly lower than that of the PG group （P〈0.05）.The multivariate analysis indicated that T/N stage was an independent prognostic risk factor in typeⅡAEG patients, while TNM stage was an independent prognostic factor in type Ⅲ AEG patients.Multivariate prognostic analysis revealed that T/N stage was a risk f

关 键 词： 食管胃结合部腺癌 手术治疗 分型 预后生存 生活质量