目的：探讨不同近端胃癌根治性切除术及重建术式的临床效果与术后生存情况。 方法：分析2006 年1 月—2011 年10 月82 例行近端胃癌根治切除术患者资料，其中22 例行近端胃切 除术后食管残胃吻合重建（食管胃吻合组），40 例行全胃切除术后Roux-en-Y 食管空肠吻合重建（食 管空肠Roux-en-Y 吻合组），20 例行近端胃切除术后功能性空肠间置重建（空肠间置组），比较三组 患者手术指标、术后并发症、营养状态以及术后生存率。 结果：食管胃吻合组手术时间、出血量均明显少于另两组（均P<0.05）；食管空肠Roux-en-Y 吻合 组淋巴结清扫数明显多于另两组，但营养指标方面不如另两组（均P<0.05）；三组并发症总发生率 均无统计学差异（P>0.05），但食管空肠Roux-en-Y 吻合组腹泻、倾倒综合征发生率明显高于另两 组（均P<0.05）；三组患者1、3 年生存率差异均无统计学意义（χ2=0.891，P=0.554；χ2=0.419， P=0.831）。 结论：三种近端胃癌手术生存率相似，近端胃切除术加食管残胃吻合创伤性小，近端胃切除术加功能 性空肠间置术后生活质量更高，临床应根据患者实际情况选择方案。
Clinical analysis of different types of radical gastrectomy and reconstruction for proximal gastric cancer
Objective: To investigate clinical efficacy and postoperative survival in proximal gastric cancer patients undergoing different types of radical gastrectomy and reconstruction. Methods: The clinical records of 82 patients with proximal gastric cancer undergoing radical gastrectomy from January 2006 to October 2011 were analyzed. Of the patients, 22 cases underwent proximal gastrectomy with esophageal-residual stomach anastomosis (esophagogastric anastomosis group), 40 cases underwent total gastrectomy with esophagojejunal Roux-en-Y anastomosis (esophagojejunal Roux-en-Y anastomosis group), and 20 cases underwent proximal gastrectomy with functional jejunal interposition (jejunal interposition group). The surgery-related parameters, and postoperative complications, nutritional status and survival rate among the three groups were compared. Results: The operative time and intraoperative blood loss in esophagogastric anastomosis group were significantly decreased compared with the other two groups, and the number of lymph nodes dissected was higher but the nutritional indexes were worse in esophagojejunal Roux-en-Y anastomosis group than those in the other two groups (all P<0.05). There was no statistical difference in incidence of overall postoperative complications (P>0.05), but the incidences of diarrhea and dumping syndrome in esophagojejunal Roux-Y anastomosis group were significantly higher than those in the other two groups (all P<0.05). No statistical difference was noted in 1- and 3- year survival rate among the three groups (χ2=0.891, P=0.554; χ2=0.419, P=0.831). Conclusion: The three procedures give similar postoperative survival rate for proximal gastric cancer, and of them, proximal gastrectomy plus esophageal-residual stomach anastomosis is less traumatic, while proximal gastrectomy with functional jejunal interposition offers better quality of life, so the procedure selection should be based on the actual clinical condition of the patient.