关键词: 胃癌, 近端胃切除术, 消化道重建, 反流性食管炎, 双肌瓣吻合, 食管残胃侧壁吻合, 生活质量

Abstract: To compare the postoperative quality of life and efficacy of different digestive tract reconstruction methods after proximal gastrectomy. Methods    A retrospective analysis was conducted on the clinicopathological data of 290 patients who underwent radical proximal gastrectomy at four centers from January 2018 to December 2023. Based on the reconstruction methods, the patients were divided into the following groups: 83 cases in the Gastroesophageal End-to-Side Anastomosis group, 74 cases in the Pouch Anastomosis group, 54 cases in the Double Tract Anastomosis group, 56 cases in the SOFY Anastomosis group, and 23 cases in the Kamikawa Anastomosis group. The observation indicators, including perioperative indicators, endoscopic reflux grading, nutritional status indicators, follow-up, and survival conditions, were compared between different groups. The follow-up period extends until April 2024. Results  There were no statistically significant differences among the groups in terms of the number of lymph node metastases, reoperation rate, incidence of Grade III and above complications, and perioperative mortality rate (P>0.05). The End-to-Side group and SOFY group had significantly higher intraoperative blood loss compared to the other groups (P<0.05). The Pouch group had significantly longer postoperative nasogastric tube retention days and hospital stays compared to the other groups (P<0.05). The Kamikawa group showed a significant increase in the number of lymph nodes dissected and a lower incidence of postoperative complications compared to the other groups (P<0.05). The End-to-Side group and Pouch group had higher postoperative mortality and recurrence rates compared to the other groups (P<0.05). The incidence of Grade B or higher reflux esophagitis was 31.1%. The SOFY group and Kamikawa group showed significantly less postoperative reflux progression compared to the other groups (P<0.05). One year after surgery, the Pouch group, SOFY group, and Kamikawa group completed PGSAS-45. There was no statistically significant difference in SF-8 quality of life, survival status, and quality of life among the three groups (P>0.05). In terms of gastrointestinal symptoms, the Kamikawa group was significantly better than the gastric tube group and SOFY group (P<0.05). Conclusion    Among the different digestive tract reconstruction methods after proximal gastrectomy, SOFY anastomosis, and Kamikawa anastomosis have similar efficacy and are safe and feasible. They also offer greater advantages in postoperative anti-reflux compared to other anti-reflux techniques.

Key words: gastric cancer, proximal gastrectomy, digestive tract reconstruction, reflux esophagitis, double flap anastomosis, side overlap with fundoplication, quality of life