腹腔镜近端胃切除Kamikawa吻合术与间置空肠双通道吻合术近期临床疗效  

Short-term clinical efficacy of Kamikawa anastomosis and jejunal interposed double channel anastomosis in laparoscopic proximal gastrectomy

作　　者：魏伟 范林广 崔鹏 宗亮 宋东阳 王杰 张克昌 张晋杰 胡文庆[1] Wei Wei;Fan Linguang;Cui Peng;Zong Liang;Song Dongyang;Wang Jie;Zhang Kechang;Zhang Jinjie;Hu Wenqing(Changzhi People's Hospital Affiliated to Changzhi Medical College,Changzhi 046000,Shanxi Province,China;Dazhou Central Hospital,Dazhou 635000,Sichuan Province,China;Heji Hospital Affiliated to Changzhi Medical College,Changzhi 046011,Shangxi Province,China)

机构地区：[1]长治医学院附属长治市人民医院,长治046000 [2]达州市中心医院,达州635000 [3]长治医学院附属和济医院,长治046011

出　　处：《中华消化外科杂志》2022年第9期1218-1224,共7页Chinese Journal of Digestive Surgery

基　　金：山西省重点研发计划项目(201803D31083);山西省卫健委科研课题(2018134);山西省卫生健康委科研课题(2021011)。

摘　　要：目的探讨腹腔镜近端胃切除Kamikawa吻合术与间置空肠双通道吻合术近期临床疗效。方法采用回顾性队列研究方法。收集2018年3月至2020年12月国内2家医学中心收治的68例(长治医学院附属长治市人民医院63例、长治医学院附属和济医院5例)食管胃结合部和胃上部肿瘤行腹腔镜近端胃切除术患者的临床病理资料;男57例,女11例;年龄为62(39~78)岁。68例患者中,35例行腹腔镜近端胃切除Kamikawa吻合术设为Kamikawa组,33例行腹腔镜近端胃切除置空肠双通道吻合术设为双通道组。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chew‑wun wu特殊症状量表评分、术后反流性食管炎、吻合口狭窄情况。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)表示,组间比较采用Mann‑Whitney U检验,等级资料比较采用非参数秩和检验。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。结果(1)术中情况。68例患者均顺利完成腹腔镜近端胃切除联合D1+淋巴结清扫术。Kamikawa组和双通道组患者手术时间、术中出血量分别为(5.15±0.31)h、(89±11)mL和(4.21±0.11)h、(142±20)mL,两者上述指标比较,差异均有统计学意义(t=2.81,-2.34,P<0.05);消化道重建时间、淋巴结清扫数目分别为(1.95±0.13)h、(30.4±2.4)枚和(1.69±0.76)h、(28.0±2.4)枚,两者上述指标比较,差异均无统计学意义(t=1.79,0.73,P>0.05)。(2)术后情况。Kamikawa组和双通道组患者术后首次肛门排气时间、引流管放置时间、术后住院时间分别为(3.03±0.12)d、(5.46±0.22)d、(13.00±0.50)d和(4.42±0.21)d、(9.97±0.76)d、(16.46±0.92)d,两者上述指标比较,差异均有统计学意义(t=-5.80,-5.58,3.40,P<0.05);引流管放置(有、无)分别为32、3例和33、0例,两者比较,差异无统计学意义(PObjective To investigate the short-term clinical efficacy of Kamikawa anastomosis and jejunal interposed double channel anastomosis in laparoscopic proximal gastrectomy.Methods The retrospective cohort study was conducted.The clinicopathological data of 68 patients with esophagogastric junctional tumors and upper gastric tumors who underwent laparoscopic proximal gastrectomy in two medical centers,including 63 cases in the Changzhi People's Hospital Affiliated to Changzhi Medical College and 5 cases in the Heji Hospital Affiliated to Changzhi Medical College,from March 2018 to December 2020 were collected.There were 57 males and 11 females,aged 62(range,39‒78)years.Of 68 patients,35 patients undergoing Kamikawa anastomosis in laparoscopic proximal gastrectomy were allocated into Kamikawa group,and 33 patients undergoing jejunal interposed double channel anastomosis in laparoscopic proximal gastrectomy were allocated into double channel group.Observation indicators:(1)intraoperative situations;(2)postoperative situations;(3)follow-up.The patients were followed up by outpatient examinations and telephone interview to detect the postoperative score of chew-wun wu special symptoms,postoperative reflux anastomotic esophagitis and anastomotic stenosis up to December 2021.Measurement data with normal distri-bution were represented as Mean±SD,and comparison between groups was performed by the t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was conducted by Mann-Whitney U test.Comparison of ordinal data was performed by nonparametric rank sum test.Count data were expressed as absolute numbers,and comparison between groups was conducted using the chi-square test or Fisher exact probability method.Results(1)Intraoperative situations.All the 68 patients successfully underwent laparoscopic proximal gastrectomy combined with D1+lymph node dissection.The operation time and volume of intraoperative blood loss of the Kamikawa group were(5.15±0.31)hours and(89±11)mL,

关 键 词：胃肿瘤 食管胃结合部肿瘤 近端胃切除 Kamikawa吻合 双通道吻合 临床疗效 腹腔镜检查 

分 类 号：R735.2[医药卫生—肿瘤]