两种术式对进展期胃上部癌术后辅助化疗耐受性的影响-东南大学学报医学版

两种术式对进展期胃上部癌术后辅助化疗耐受性的影响

单位：1. 南京中医药大学第一临床医学院, 江苏南京 210046;
2. 南京中医药大学附属江苏省中医院肿瘤外科, 江苏南京 210029

分类号：R735.2;R730.53

出版年·卷·期（页码）：2014·33·第三期（277-282）

摘要：

目的：比较近端胃切除和全胃切除对术后辅助化疗耐受性及完成率的影响。方法：回顾性分析142例胃上部癌病例不同术式对术后化疗的影响，观察严重不良反应的发生率、导致化疗终止的原因及内镜下反流性食管炎发病率及吻合口病变。结果：85例行近端胃切除，57例行全胃切除，术后化疗的完成率两组分别为21.2%和54.4%；化疗严重不良反应发生率近端胃切除组为48.2%，高于全胃切除组；导致化疗不耐受的原因中，近端胃切除组消化道不良反应所占比例为43.3%，尤其是呕吐反应的发生率达到35.8%，明显高于全胃切除组；近端胃切除组反流性食管炎及吻合口溃疡的发生率亦明显高于全胃切除组，差异均具有统计学意义。结论：近端胃切除组病例术后化疗不良反应发生率高，化疗完成率低，这一术式是否合理有待商榷及进一步研究。

Objective:To examine the difference of the effcts of two different surgical methods for proximal gastric cancer on adjuvant chemotherapy tolerance and completion rates.Methods:Retrospectively research the influence of two different surgical methods for 142 patients of proximal gastric cancer on postoperative chemotherapy,observe the incidence of serious adverse effects, the cause of the termination of chemotherapy, the incidence of reflux esophagitis and the anastomotic lesions by endoscopic observation. Results:142 patients with proximal gastric cancer was divied into 57 cases of total gastrectomy group and 85 cases of proximal gastrectomy group.The completion rates of postoperative chemotherapy of the two groups were respectively 21.2% and 54.4%,and the incidence of serious adverse reaction of proximal gastrectomy group was 48.2% which was much higher than total gastrectomy group. Gastrointestinal adverse reactions rate was accounted for 43.3% in proximal gastrectomy group, especially the vomiting reaction rate which was higher reached 35.8% among all the causes of chemotherapy intolerance. The incidence reflux esophagitis and anastomotic ulcer in proximal gastrectomy group was also higher than total gastrectomy group, and all the difference had statistical significance. Conclusion:Proximal gastrectomy group get higher incidence of postoperative chemotherapy side effects but lower chemotherapy completion rate, so whether it is reasonable of this surgical methods need further research.

参考文献：

[1] KATAI H,SANO T,FUKAGAWA T,et al.Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach[J].Br J Surg,2003,90(7):850-853.
[2] YOO C H,SOHN B H,HAN W K,et al.Proximal gastrectomy reconstructed by jejunal pouch interposition for upper third gastric cancer:prospective randomized study[J].World J Surg,2005,29(12):1592-1599.
[3] HOYA Y,MITSUMORI N,YANAGA K.The advantages and disadvantages of a Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer[J].Surg Today,2009,39(8):647-651.
[4] SAKURAMOTO S,SASAKO M,YAMAGUCHI T,et al.Adjuvant chemotherapy for gastric cancer with S-1,an oral fluoropyrimidine[J].N Engl J Med,2007,357(18):1810-1820.
[5] SASAKO M,SAKURAMOTO S,KATAI H,et al.Five-year outcomes of a randomized phase Ⅲ trialcomparing adjuvant chemotherapy with S-1 versus surgery alone in stage Ⅱ or Ⅲ gastric cancer[J].J Clin Oncol,2011,29(33):4387-4393.
[6] ZHANG J,CHEN R X,ZHANG J,et al.Efficacy and safety of neoadjuvantchemotherapy with modified FOLFOX7 regimen on the treatment of advanced gastric cancer[J].Chin Med J(Engl),2012,125(12):2144-2150.
[7] VASILESCU C,POPA M,TUDOR S,et al.Robotic surgery of locally advanced gastric cancer-an initial experience[J].Acta Chir Belg,2012,112(3):209-212.
[8] GASTRIC(Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group,PAOLETTI X,OBA K,et al.Benefit of adjuvant chemotherapy for resectable gastric cancer:a meta-analysis[J].J Am Med Assoc,2010,303(17):1729-1737.
[9] AN J Y,YOUN H G,CHOI M G,et al.The difficult choice between total and proximal gastrectomy in proximal early gastric cancer[J].Am J Surg,2008,196(4):587-591.
[10] OTT K,LORDICK F,BLANK S,et al.Gastric cancer:surgery in 2011[J].Langenbecks Arch Surg,2011,396(6):743-758.
[11] LUNDELL L,MIETTINEN P,MYRVOLD H E,et al.Seven-year follow up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis[J].Br J Surg,2007,94(2):198-203.
[12] KATSOULIS I E,ROBOTIS J F,KOURAKLIS G,et al.What is difference between proximal and total gastrectomy regarding postoperative bile reflux into the oesophagus？[J].Dig Surg,2006,23(5-6):325-330.
[13] KIM J H,PARK S S,KIM J,et al.Surgical outcomes for gastric cancer in the upper third of the stomach[J].Word J Surg,2006,30(10):1870-1876.
[14] ZHANG H,SUN Z,XU H M,et al.Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction[J].World J Gastroenterol,2009,15(25):3183-3190.
[15] TOKUNAGA M,OHYAMA S,HIKI N,et al.Endoscopic evaluation of reflux esophagitis after proximal gastrectomy:comparison between esophagogastric anastomosis and jejunal interposition[J].World J Surg,2008,32(7):1473-1477.
[16] SAKURAMOTO S,YAMASHITA K,KIKUCHI S,et al.Clinical experience of laparoscopy-assisted proximal gastrectomy with Toupet-like partial fundoplication in early gastric cancer for preventing reflux esophagitis[J].J Am Coll Surg,2009,209(3):344-351.
[17] MATSUI H,IGARASHI N,ITANO O,et al.Laparoscopic function-preserving surgery for early gastric cancer in the upper third of the stomach:vagus-sparing proximal gastrectomy with side-to-side esophagogastric-tube anastomosis[J].Tokai J Exp Clin Med,2007,32(4):109-114.
[18] TAKIGUCHI S,MASUZAWA T,HIRAO M,et al.Pattern of surgical treatment for early gastric cancers in upper third of the stomach[J].Hepatogastroenterology,2011,58(110-111):1823-1827.
[19] HARRISON L E,KARPEH M S,BRENNAN M F,et al.Total gastrectomy is not necessary for proximal gastric cancer[J].Surgery,1998,123(2):127-130.
[20] PARACHRISTOU D N,FORTNER J G.Adenocarcinoma of the gastric cardia,the choice of gastrectom[J].Ann Surg,1980,192(1):58-64.
[21] 袁晓东.进展期胃远侧癌的淋巴结转移和手术治疗[J].东南大学学报:医学版,2001,20(4):269-270.
[22] JI Y A,HO G Y,MIN G C.The difficult choice between total and proximal gastrectomy in proximal early gastric cancer[J].Am J Surg,2008,196(4):587-591.
[23] WEN L,CHEN X Z,WU B,et al.Total vs.Proximal gastrectomy for proximal gastric cancer.A systematic review and Meta-Analysis[J].Hepatogastroenterology,2012,59(114):633-640.
[24] BOGOEVSKI D,BOCKHORN M,KOENIG A,et al.How radical should surgery be for early esophageal cancer[J].World J Surg,2011,35(6):1311-1320.
[25] NAMIKAWA T,OKI T,KITAGAWA H,et al.Impact of jejunal pouch interposition reconstruction after proximal gastrectomy for early gastric cancer on quality of life:short-and long-termconsequences[J].Am J Surg,2012,204(2):203-209.
[26] MANN N S,RACHUT E.Carcinoma of gastric stump cansing afferent loop obstruction and acute pancreatitis[J].Hepatogastroenterology,2004,51(55):184-185.
[27] 吴星宇,席时富.胃癌病理学的变化及其与外科治疗的关系[J].现代医学,2004,32(6):399-400.

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