Abstract: 【Abstract】〓Objective〓To compare complications, nutritional status and quality of life between total gastrectomy and proximal radical gastrectomy in patients with advanced proximal gastric carcinoma. Methods〓Eighty-five patients with proximal stomach cancer were enrolled from Jan 2002 to Dec 2008 and underwent total gastrectomy (total gastrectomy group,n=40) and proximal radical gastrectomy (proximal radical gastrectomy group,n=45). Nutritional status, incidence of reflux esophagitis and cholecystolithiasis, 5-year survival rate, quality of life were investigated. Results〓Median survival time of total gastrectomy group and proximal radical gastrectomy group were 41 months and 46 months respectively. There was no significant difference in 5-year survival rate between two groups (P>0.05). There was significant difference in incidence of reflux esophagitis between total gastrectomy group and proximal radical gastrectomy group (10/40, 25% vs. 4/45, 8.9%, P<0.05). There was significant difference in incidence of cholecystolithiasis between total gastrectomy group and proximal radical gastrectomy group (11/40, 27.5% vs. 4/45, 8.9%,P<0.05). Hemoglobin, albumin, vitamin B12 and ferritin in proximal radical gastrectomy group were higher than those in total gastrectomy group (142.2±10.6 vs. 128.4±11.4; 41.3±5.8 vs. 35.9±3.8; 271.5±39.7 vs. 184.5±24.6; 220.2±59.7 vs. 170.2±27.6; P<0.05). Diet and labor in proximal radical gastrectomy group were better than those in total gastrectomy group (P<0.05). Conclusion〓Proximal radical gastrectomy decreases incidence of reflux esophagitis and cholecystolithiasis, improve nutritional status and quality of life.

Key words: Total gastrectomy, Proximal radical gastrectomy, Complication, Nutrition, Quality of life

摘要： 【摘要】〓目的〓探讨全胃切除术与近端胃癌根治术对进展期近端胃癌(肿瘤直径>3 cm)患者术后并发症、营养状况和生活质量的影响。方法〓回顾性分析我院2002年1月至2008年12月近端胃癌患者85例,其中全胃切除术40例,近端胃癌根治术45例,调查术后营养状况、反流性食管炎发生率、术后胆囊结石发生率、5年生存率和术后生活质量。两组患者性别、年龄、肿瘤直径、手术时间、住院时间、住院费用、淋巴结清扫数目、术前营养指标和术后并发症均无统计学差异。结果〓全胃切除组和近端胃癌根治组患者中位生存期分别为41个月和46个月,5年生存率分别为52.5%(21/40)和55.6%(25/45),均无显著统计学差异(P>0.05)。全胃切除组和近端胃癌根治组术后反流性食管炎发生率分别为25.0%(10/40)和8.9%(4/45),有显著的统计学差异(P<0.05)。全胃切除组和近端胃癌根治组患者术后5年累计胆囊结石发生率分别为27.5%(11/40)和8.9%(4/45),有显著的统计学差异(P<0.05)。近端胃癌根治组术后血红蛋白、白蛋白、维生素B12和铁蛋白均显著高于全胃切除组,有统计学差异(142.2±10.6 vs. 128.4±11.4; 41.3±5.8 vs. 35.9±3.8; 271.5±39.7 vs. 184.5±24.6; 220.2±59.7 vs. 170.2±27.6; P<0.05)。近端胃癌根治组患者术后饮食情况和劳动情况均优于全胃切除组,有显著的统计学差异(P<0.05)。结论〓近端胃癌根治术不影响进展期近端胃癌(肿瘤直径>3 cm)患者5年生存率,可以降低术后反流性食管炎和胆囊结石发生率,改善术后营养状况和生活质量。

关键词: 全胃切除, 近端胃癌根治切除, 并发症, 营养, 生活质量