中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (10): 1147-1151.DOI: 10.19538/j.cjps.issn1005-2208.2022.10.15

• 论著 • 上一篇    下一篇

腹腔镜近端胃切除术双通道与食管胃吻合近期疗效和生活质量对比研究

王子健1,2，高云鹤 2，胡    鹏1,2，李    力1,2，王鑫鑫2，陈    凛2   

  1. 1中国人民解放军医学院，北京100853；2中国人民解放军总医院第一医学中心普通外科医学部，北京100853
  • 出版日期:2022-10-01 发布日期:2022-10-13

  • Online:2022-10-01 Published:2022-10-13

摘要： 目的    比较腹腔镜近端胃切除术双通道吻合与食管胃吻合治疗的近期临床效果和术后生活质量。
方法    回顾性分析2020年6月至2021年6月中国人民解放军总医院第一医学中心普通外科收治的84例行腹腔镜近端胃切除术病人的临床资料，根据消化道重建方式分为双通道组（40例，行双通道吻合），食管胃组（44例，行食管胃吻合）。比较两组病人的基本资料、手术相关指标、术后恢复指标及相关并发症，通过Visick 分级、EORTC QLQ-C30和 EORTC QLQ-STO22 量表联合评估术后 1 年两组病人的生活质量。结果    与双通道组相比，食管胃组病人手术时间更短，手术费用更低，差异有统计学意义（P<0.05），两组术中失血量、淋巴结清扫数目、肛门首次排气时间、首次进清流食时间、术后住院时间差异均无统计学意义（P＞0.05）。两组病人的早期并发症发生率以及Clavien-Dindo分级的差异均无统计学意义（P＞0.05）。双通道组18例病人完成术后7 d消化道造影，61%的病人消化道造影呈双通道。术后随访 12个月，双通道组 Visick分级优于食管胃组（P=0.040）；EORTC QLQ-C30问卷调查显示双通道组病人总健康状况较好（P=0.040），恶心呕吐和食欲减退症状较少；EORTC QLQ-STO22问卷调查显示双通道组反流症状较少（P=0.030）。两组病人BMI均下降，双通道组BMI下降差值低于食管胃组（P=0.019）。结论    近端胃切除术消化道重建方式中，食管胃吻合较双通道吻合的手术时间更短，手术费用更低；双通道吻合术后实际呈现单通道与双通道两种状态，双通道吻合病人在术后生活质量和BMI维持方面优于食管胃吻合。

关键词: 胃癌, 近端胃切除术, 双通道吻合, 食管胃吻合, 腹腔镜

Abstract: A comparative study on short-term outcomes and quality of life of proximal gastrectomy with double tract reconstruction and esophagogastrostomy        WANG Zi-jian*，GAO Yun-he，HU Peng， et al. *Chinese PLA Medical School；Department of General Surgery，the First Medical Center of Chinese PLA General Hospital，Beijing 100853，China 
Corresponding authors: WANG Xin-xin E-mail:301wangxx@sina.com ；CHEN Lin E-mail: chenlinbj@sina.com
Abstract    Objective    The aim of the present study was to compare the the short-term clinical effects between double tract reconstruction and esophagogastrostomy. Methods    The clinical and follow-up data of 84 patients with primary proximal gastric cancer in the First Medical Center of PLA General Hospital were retrospectively analyzed. According to the digestive tract reconstruction mode, it was divided into a two-channel group (40 cases, with the double tract reconstruction) and an esophageal residual gastric group (44 cases, with esophageal residual gastric anastomosis). The basic data, operation-related indicators, postoperative recovery indicators and related complications of the two groups were collected and compared. The quality of life of the two groups was assessed by Visick grading, EORTC QLQ-C30 and EORTC QLQ-STO22 scales at 1 year after operation. The nutritional status of the two groups was evaluated by BMI. Results    Compared with the double tract reconstruction group, the operation time of esophagogastrostomy group was shorter (P=0.03), and the operation cost was less (P＜0.001). There were no significant differences in intraoperative blood loss, number of lymph nodes dissected, time of first anal exhaust, time of first clear liquid diet and postoperative length of stay between the two groups (P>0.05). There was no significant difference in the incidence of early complications and Clavien-Dindo classification between two groups (P>0.05). Digestive tract angiography was performed 7 days after operation in 18 patients with double tract reconstruction, and the effective rate was 61%. One year later the Visick grade of the double tract reconstruction group was better than esophagogastrostomy group (P=0.040). Patients in the double tract reconstruction group had a better global health status (P=0.040)  and complained less about nausea and vomiting, and appetite loss based on the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. Regarding the EORTC QLQ-STO22 questionnaire, patients in the double tract reconstruction group complained less about reflux (P=0.030，P＜0.05), BMI of both groups decreased 1 year after surgery. BMI decline value of the double tract reconstruction group was lower than esophagogastrostomy group (P=0.019). Conclusion    The operation time of esophagogastrostomy are shorter than double tract reconstruction, and the operation cost was less. There were actually two states after double tract reconstruction: single-channel and double-channel. double tract reconstruction was superior to esophagogastrostomy in postoperative quality of life and maintenance BMI.

Key words: gastric cancer, proximal gastrectomy, double tract reconstruction, esophagogastrostomy, laparoscope