腹腔镜辅助保留幽门胃切除术改善早期胃癌术后胆汁反流性胃炎前瞻性随机对照研究  

Laparoscopic assisted pylorus-preserving gastrectomy reducing postoperative bile reflux gastritis:A single center prospective randomized controlled study

作　　者：夏翔 沈艳莹[2] 朱纯超[1] 吕恒宇 黄晨[1] 曹晖[1] 赵刚[1] 张子臻[1] XIA Xiang;SHEN Yan-ying;ZHU Chun-chao(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;不详)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127 [2]上海交通大学医学院附属仁济医院病理科,上海200127

出　　处：《中国实用外科杂志》2020年第5期557-562,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.81802313,No.81972206);上海市卫计委百人计划(No.2017BR043);上海申康发展中心三年行动计划疑难疾病精准诊治攻关项目(No.16CR2022A);浦东新区联合攻关项目(No.PW2017D-1);上海交通大学医学院附属仁济医院临床科研创新培育基金(No.PYⅢ-17-015)。

摘　　要：目的比较腹腔镜辅助保留幽门胃切除术(LAPPG)与腹腔镜辅助远端胃大部切除术(LADG)(BillrothⅠ式吻合)对胃体中部早期胃癌病人术后继发性胆汁反流性胃炎(BRG)的影响。方法自2018年2月至2018年12月,对上海交通大学医学院附属仁济医院胃肠外科收治的69例早期胃体中部癌(cT1N0M0)病人进行1∶1前瞻性随机化入组,其中LAPPG组(行LAPPG)34例,LADG组(行LADG,BillrothⅠ式吻合)35例,进行6个月随访,比较两组术前、术中、术后及随访结果。结果两组病人在年龄、性别、BMI、术前合并症及术后病理诊断的基线水平差异无统计学意义(P>0.05)。两组淋巴结清扫数目、手术时间、术中出血量、术后首次排气时间、胃管拔除时间、Ⅱ级以上并发症差异无统计学意义(P>0.05)。术后6个月随访结果显示,BRG临床表现无特异性,在两组中差异无统计学意义(P>0.05);但内镜下诊断BRG比例LAPPG组显著低于LADG组,差异有统计学意义[3例(8.8%)vs.16例(45.7%),χ^2=11.763,P=0.001];LAPPG组中Kellosalofen分级Ⅱ度以上BRG的比例显著低于LADG组,差异有统计学意义[2例(5.7%)vs.9例(25.7%),χ^2=5.062,P=0.024];组织学活检发现LADG组胃小凹增生1例、腺体萎缩伴肠化3例,LAPPG组未观察到上述病理组织学异常,但两组差异无统计学意义(P>0.05)。结论LAPPG治疗早期胃体中部癌安全可行,该术式较LADG可改善术后BRG的发生率及严重程度。其对病人术后长期疗效及残胃癌发生率的影响仍有待大样本RCT研究的长期随访证实。Objective To evaluate the effects of laparoscopic assisted pylorus-preserving gastrectomy(LAPPG)and laparoscopic assisted distal gastrectomy(LADG)with Billroth I anastomosis on bile reflux gastritis(BRG)in patients with middle-third early gastric cancer.Methods From February 2018 to December 2018,69 patients with middle-third early gastric cancer(cT1N0M0)admitted to the Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine were randomly divided into LAPPG and LADG groups(1:1),and then were followed up for 6 months.There were 34 patients in LAPPG groups who underwent LAPPG,and 35 patients in LADG groups who underwent LADG with Billroth I anastomosis.The results of preoperative,intraoperative,postoperative and follow-up were compared between the two groups.Results There was no significant difference in age,gender,BMI,preoperative complications,tumor size and low differentiation proportion between the two groups(P>0.05).There was no significant difference in the number of lymph node examination,operation time,intraoperative bleeding,the time of the first postoperative exhaust,the time of gastric tube extraction and postoperative complications above levelⅡbetween the two groups(P>0.05).Six months follow-up results showed that there was no significant difference in BRG related clinical symptom and BMI changes between the two groups.The proportion of BRG diagnosed by endoscopy in LAPPG(3 cases,8.8%)was significantly lower than that in LADG group(16 cases,45.7%)(χ^2=11.763,P=0.001).Among them,there were 2 cases(5.7%)above BRGⅡdegree in LAPPG which was significantly lower than LADG(9 cases,25.7%)(χ^2=5.062,P=0.024).Histologic biopsy showed 1 case of gastric fovea hyperplasia and 3 cases of glandular atrophy with intestinal metaplasia in LADG group,but there was no significant difference between the two groups(P>0.05).Conclusion LAPPG is safe and feasible procedure for patients with middle-third early gastric cancer.Compared with LADG,LAPPG can improve the incidence a

关 键 词：早期胃癌 腹腔镜辅助保留幽门胃切除术 腹腔镜辅助远端胃大部切除术 胆汁反流性胃炎 

分 类 号：R6[医药卫生—外科学]