自牵引后离断技术在全腹腔镜近端胃切除双重抗反流双通道重建中的应用价值  

Application value of self-pulling and latter transection technique in double anti-reflux doubletract reconstruction of totally laparoscopic proximal gastrectomy

作　　者：陶凯[1] 马俊[1] 张万红[1] 王振华[1] 马国龙[1] 任一鹏 李林杰 高斐 董剑宏[1] 黄庆兴[1] Tao Kai;Ma Jun;Zhang Wanhong;Wang Zhenhua;Ma Guolong;Ren Yipeng;Li Linjie;Gao Fei;Dong Jianhong;Huang Qingxing(Digestive Minimally Invasive Surgery Center,Shanxi Cancer Hospital,Gastric Cancer Center of Shanxi Province,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院消化微创外科中心山西省胃癌中心,太原030013

出　　处：《中华消化外科杂志》2022年第3期401-407,共7页Chinese Journal of Digestive Surgery

基　　金：山西省卫生健康委青年课题(2017069)。

摘　　要：目的探讨自牵引后离断(SPLT)技术在全腹腔镜近端胃切除双重抗反流双通道重建中的应用价值。方法采用回顾性队列研究方法。收集2018年1月至2020年1月山西省肿瘤医院收治的103例临床分期Ⅰ~Ⅱ期食管胃结合部腺癌(AEG)患者(SiewertⅡ型)的临床病理资料;男65例,女38例;中位年龄为59岁,年龄范围为45~79岁。103例患者中,49例行SPLT全腹腔镜近端胃切除双通道重建,设为SPLT组;54例行传统全腹腔镜近端胃切除双通道重建,设为传统组。观察指标:(1)术中情况。(2)术后情况。(3)随访情况。采用门诊和电话方式进行随访,了解患者术后反流性食管炎发生情况。随访时间截至2021年12月。正态分布的计量资料以x±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)或M(Q_(1),Q_(3))表示,组间比较采用Wilcoxon检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验。等级资料比较采用非参数秩和检验。结果(1)术中情况:SPLT组患者手术时间、消化道重建时间、术中出血量、下纵隔淋巴结清扫数目、中转辅助分别为(261±48)min、(26±4)min、(114±42)mL、8.0(6.5,9.5)枚、1例;传统组患者上述指标分别为(244±42)min、(30±6)min、(118±46)mL、5.5(4.0,8.0)枚、9例;两组患者消化道重建时间、下纵隔淋巴结清扫数目、中转辅助比较,差异均有统计学意义(t=-3.34,Z=-4.05,χ^(2)=4.72,P<0.05);两组患者手术时间、术中出血量比较,差异均无统计学意义(t=1.87,-0.47,P>0.05)。(2)术后情况:SPLT组患者术后住院时间、术后并发症分别为(11.5±2.7)d、4例;传统组患者上述指标分别为(12.5±4.3)d、9例;两组患者上述指标比较,差异均无统计学意义(t=-1.47,χ^(2)=1.68,P>0.05)。103例患者中,13例发生术后并发症,其中左侧胸腔积液5例、吻合口漏4例、轻度肺炎2例、切口感染1例、乳糜漏1例。4例患者发生吻合口漏,位置均在食管-空肠吻合口处,Objective To investigate the application value of self-pulling and latter transection(SPLT)technique in double anti-reflux double-tract reconstruction of totally laparoscopic proximal gastrectomy.Methods The retrospective cohort study was conducted.The clinicopathological data of 103 patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction in clinical stage Ⅰ-Ⅱ who were admitted to Shanxi Cancer Hospital from January 2018 to January 2020 were collected.There were 65 males and 38 females,aged from 45 to 79 years,with a median age of 59 years.Of 103 patients,49 cases undergoing totally laparoscopic proximal gastrectomy with double-tract reconstruction of SPLT were assigned into the SPLT group,54 cases undergoing totally laparoscopic proximal gastrectomy with conventional double-tract reconstruction were assigned into the traditional group.Observation indicators:(1)intraoperative situations;(2)postoperative situations;(3)follow-up.Follow-up was conducted by outpatient examination and telephone interview to detect postoperative reflux esophagitis of patients up to December 2021.Measurement data with normal distribution were represented as Mean±SD,and the t test was used for comparison between groups.Measurement data with skewed distribution were represented as M(range)or M(Q_(1),Q_(3)),and the Wilcoxon test was used for comparison between groups.Count data were described as absolute numbers or percentages,and comparison between groups was performed using the chisquare test.Comparison of ordinal data was analyzed using the non-parameter rank sum test.Results(1)Intraoperative situations:the operation time,digestive tract reconstruction time,volume of intraoperative blood loss,the number of inferior mediastinal lymph nodes dissected,cases with auxiliary incisions for the SPLT group were(261±48)minutes,(26±4)minutes,(114±42)mL,8.0(6.5,9.5),1,respectively.The above indicators were(244±42)minutes,(30±6)minutes,(118±46)mL,5.5(4.0,8.0),9 for the traditional group,respectively.There were significan

关 键 词：胃肿瘤 食管胃结合部腺癌 双通道 近端胃切除 自牵引 腹腔镜检查 

分 类 号：R735[医药卫生—肿瘤]