早期胃上部癌腹腔镜近端胃切除双通道吻合与腹腔镜全胃切除Roux-en-Y吻合两种消化道重建术式的疗效比较  

Efficacy of laparoscopic proximal gastrectomy with double-tract reconstruction versus laparoscopic total gastrectomy with Roux-en-Y reconstruction for early upper gastric cancer

作　　者：仇广林[1] 魏超 朱梦珂 韩尚宁 李啸文 王海江[1] 王盼兴 刘家煌 周华友[3] 廖新华[1] 车向明[1] 樊林[1] Qiu Guanglin;Wei Chao;Zhu Mengke;Han Shangning;Li Xiaowen;Wang Haijiang;Wang Panxing;Liu Jiahuang;Zhou Huayou;Liao Xinhua;Che Xiangming;Fan Lin(Department of General Surgery,The First Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710061,China;Clinical Medicine Teaching and Research Section,Xi'an Health School,Xi'an 710054,China;Department of General Surgery,Hanzhong Central Hospital,Hanzhong 723000,China)

机构地区：[1]西安交通大学第一附属医院普通外科,西安710061 [2]西安市卫生学校临床医学教研室,西安710054 [3]汉中市中心医院普通外科,汉中723000

出　　处：《中华胃肠外科杂志》2022年第5期412-420,共9页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81472245);陕西省重点研发计划项目(2018SF-044,2021SF-123);西安交通大学第一附属医院基础研究基金(2017QN-01)。

摘　　要：目的比较腹腔镜根治性近端胃切除双通道吻合与腹腔镜辅助根治性全胃切除Roux-en-Y吻合(R-Y吻合)这两种消化道重建术式对早期胃上部癌患者的临床疗效,为早期胃上部癌手术方式的选择提供参考。方法采用回顾性队列研究方法,分析2018年1月至2021年1月期间,西安交通大学第一附属医院普通外科同一手术治疗团队行腹腔镜近端胃切除双通道吻合或全胃切除Roux-en-Y吻合的80例早期胃上部癌患者的临床资料,按手术方式及消化道重建方式不同,分为双通道吻合组(32例)和R-Y吻合组(48例)。比较两组手术情况、术后并发症发生情况(包括术后30 d内的早期并发症和术后30 d后出现的远期并发症)以及随访情况(包括生存情况及营养状态)。生存情况用肿瘤相关生存率表示;营养状态的评估包括术后1年及2年血清总蛋白、白蛋白、总胆固醇、血红蛋白和维生素B_(12)水平以及体质量的变化,采用降低率表示,降低率=(术前值-术后观测时间点值)/术前值×100%。非正态分布的计量资料以M(IQR)表示,组间比较采用Mann-Whitney U检验,非等级计数资料组间比较采用χ^(2)检验或校正的χ^(2)检验或Fisher精确概率法;等级计数资料组间比较采用Mann-Whitney U检验。采用Kaplan-Meier法计算生存率并绘制生存曲线,采用log-rank检验进行组间生存率的比较。结果两组患者基线资料比较,除年龄和肿瘤大小差异有统计学意义(均P<0.01),其他差异均无统计学意义(均P>0.05)。两组均顺利完成手术,无中转开腹、联合脏器切除或早期死亡病例。两组患者在近切缘距肿瘤上缘、术后住院时间、排气时间、进食时间、住院花费、术后早期并发症发生和远期并发症发生方面比较,差异均无统计学意义(均P>0.05),与R-Y吻合组相比,双通道吻合组远端切缘更短[(3.2±0.5)cm比(11.7±2.0)cm,t=-23.033,P<0.001]、手术时间更长[232.5(63.7)min比185.0(63.Objective To compare clinical efficacy between laparoscopic radical proximal gastrectomy with double-tract reconstruction(LPG-DTR)and laparoscopic radical total gastrectomy with Roux-en-Y reconstruction(LTG-RY)in patients with early upper gastric cancer,and to provide a reference for the selection of surgical methods in early upper gastric cancer.Methods A retrospective cohort study method was carried out.Clinical data of 80 patients with early upper gastric cancer who underwent LPG-DTR or LTG-RY by the same surgical team at the Department of General Surgery,the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to January 2021 were retrospectively analyzed.Patients were divided into the DTR group(32 cases)and R-Y group(48 cases)according to surgical procedures and digestive tract reconstruction methods.Surgical and pathological characteristics,postoperative complications(short-term complications within 30 days after surgery and long-term complications after postoperative 30 days),survival time and nutritinal status were compared between the two groups.For nutritional status,reduction rate was used to represent the changes in total protein,albumin,total cholesterol,body mass,hemoglobin and vitamin B_(12) levels at postoperative 1-year and 2-year.Non-normally distributed continuous data were presented as median(interquartile range),and the Mann-Whitney U test was used for comparison between groups.Theχ^(2) test or Fisher's exact test was used for comparison of data between groups.The Mann-Whitney U test was used to compare the ranked data between groups.The survival rate was calculated by Kaplan-Meier method categorical,and compared by using the log-rank test.Results There were no statistically significant differences in baseline data betweeen the two groups,except that patients in the R-Y group were oldere and had larger tumor.Patients of both groups successfully completed the operation without conversion to laparotomy,combined organ resection,or perioperative death.There were no significan

关 键 词：胃肿瘤 早期 胃上部 近端胃切除术 消化道重建 双通道吻合 全胃切除术 消化道重建 ROUX-EN-Y吻合 

分 类 号：R735.2[医药卫生—肿瘤]