中国实用外科杂志

中国实用外科杂志 ›› 2023, Vol. 43 ›› Issue (01): 100-107.DOI: 10.19538/j.cjps.issn1005-2208.2023.01.14

• 论著 • 上一篇    下一篇

近端胃切除双通道吻合对比管型胃食管吻合的短期疗效分析：一项基于倾向评分匹配的回顾性研究

王林俊，夏义文，李    颖，李    铮，王    森，刘宏达，李清雅，李博文，徐江浩，葛    晗，汪未知，李沣员，何中原，张殿彩，徐    皓，杨    力，徐泽宽   

  1. 南京医科大学第一附属医院普通外科，江苏南京210029
  • 出版日期:2023-01-01 发布日期:2023-01-19

  • Online:2023-01-01 Published:2023-01-19

摘要： 目的    对比分析近端胃切除双通道吻合术与近端胃切除管型胃食管吻合术的短期疗效。方法    收集2016年1月至2020年12月在南京医科大学第一附属医院胃外科行近端胃切除双通道吻合术和管型胃食管吻合术病人的临床资料，采取Logistic回归模型对两组病人的基线资料进行1∶3倾向性评分匹配（propensity score match，PSM），然后比较两组病人的手术情况、术后早期并发症、术后胃食管反流情况和营养状况等指标。结果    经1∶3 PSM后管型胃食管吻合组纳入病人20例，双通道吻合组纳入病人60例。两组间各项基线资料无统计学意义。管型胃食管吻合组与双通道吻合组在手术时间［（192±48.24）min vs. （210.26±52.91）min，P=0.184］、术中出血量［（103.2±67.1）mL vs. （121.8±84.4）mL，P=0.381］、淋巴结清扫数目［（36.65±9.47）枚 vs. （33.56±9.40）枚，P=0.214］等方面无统计学意义。两组病人在术后排气时间、术后进食时间、术后住院时间等方面无统计学意义（P>0.05）。管型胃食管吻合组早期并发症发生率为20.0%（4/20），双通道吻合组早期并发症发生率为26.7%（16/60），两组间差异无统计学意义（P=0.767）。晚期并发症方面，管型胃食管吻合组发现2例吻合口溃疡，双通道吻合组未发现远期并发症，两组间差异无统计学意义（P=0.060）。食管胃反流方面，双通道吻合组术后1年Ⅱ级及以上反流症状发生率显著低于管型胃食管吻合组（10% vs. 35%，P=0.009）。管型胃食管吻合组病人反流性食管炎发生率与B级以上反流性食管炎发生率均显著高于双通道吻合组（30% vs. 5%， P<0.001；20% vs. 1.7%，P =0.013）。营养状态方面，两组病人术后1年体重丢失率差异无统计学意义（P=0.127），然而双通道吻合组病人术后血清总蛋白（P=0.006）、血清白蛋白（P=0.024）和血红蛋白（P=0.048）上升水平显著高于管型胃食管吻合组。结论 近端胃切除管型胃食管吻合术与近端胃切除双通道吻合术均具有可靠的手术安全性。相较于管型胃食管吻合术，双通道吻合术具有更好的抗反流效果，同时也更有利于改善病人的术后营养状况。

关键词: 近端胃切除, 消化道重建, 双通道吻合, 管型胃食管吻合

Abstract: Clinical efficacy of double tract reconstruction versus gastric tube reconstruction after proximal gastrectomy: a retrospective study based on propensity score matching        WANG Lin-jun, XIA Yi-wen, LI Ying, et al. Department of General Surgery, the First Affiliated Hospital, Nanjing Medical University, Nanjing210029, China
Corresponding author: XU Ze-kuan, E-mail: xuzekuan@njmu.edu.cn
Abstract    Objective    To compare and analyze the clinical efficacy of double tract reconstruction versus gastric tube reconstruction after proximal gastrectomy. Methods    The clinical data of patients who underwent double tract reconstruction and gastric tube reconstruction after proximal gastrectomy in the Department of Gastric Surgery of the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were collected. Logistic regression model was used to conduct a 1∶3 propensity score match (PSM) on the patients' baseline data. Then the operation outcomes, incidence of early postoperative complications, postoperative gastroesophageal reflux and nutritional status of two groups were analyzed. Results    After 1∶3 PSM, 20 cases were included in the gastric tube reconstruction group and 60 cases were enrolled in the double tract reconstruction group. The baseline data of the two groups show no significant statistical difference. There was no significant statistical difference in the operation time (192±48.24 vs. 210.26±52.91, P=0.184), intraoperative bleeding (103.2±67.1 vs. 121.8±84.4, P=0.381), the number of retrieved lymph nodes (36.65±9.47 vs. 33.56±9.40, P=0.214) between the two groups. No significant difference showed between the two groups in terms of the time of first postoperative flatus, time of first postoperative feeding, and time of postoperative hospital stay. The incidence of early complications was 20.0% (4/20) in the gastric tube reconstruction group and 26.7% (10/60) in the double tract reconstruction group, which revealed no significant statistical difference (P=0.767). In terms of long-term complications, there were 2 cases of anastomotic ulcer in the gastric tube reconstruction group, and no long-term complications in the double tract reconstruction group, with no statistical difference between the two groups (P=0.060). As for the status of esophagogastric reflux, the incidence of reflux symptoms with a Visick score higher than Grade I was higher in the patients of gastric tube reconstruction group than those of double tract reconstruction group (10% vs. 35%, P=0.009). Gastroscopy showed that the incidence of reflux esophagitis and reflux esophagitis greater than grade B were higher in patients of gastric tube reconstruction group than those of double tract reconstruction group (30% vs. 5%, P<0.001; 20% vs. 1.7%, P=0.013). In terms of nutritional status 1 year after surgery, there was no significant difference in the rate of weight loss between two groups (P=0.127). However, the increase of serum albumin (P=0.024), total serum protein (P=0.006) and hemoglobin (P=0.048) in double tract reconstruction group were significantly higher than that of gastric tube reconstruction group. Conclusion    Both gastric tube reconstruction and double tract reconstruction after proximal gastrectomy are safe and feasible. Compared with gastric tube reconstruction, double tract reconstruction has a better anti-reflux effect and is more beneficial to improving the postoperative nutritional status.

Key words: proximal gastrectomy, digestive tract reconstruction, double tract reconstruction, gastric tube reconstruction