腹腔镜近端胃切除术治疗近端胃癌和食管胃结合部腺癌安全性和近期疗效的多中心研究  

The safety and short-term efficacy of laparoscopic proximal gastrectomy for proximal gastric cancer and adenocarcinoma of esophagogastric junction:a multicenter study

作　　者：尤俊[1] 牛兆建[2] 樊林[3] 王宽[4] 赵永亮 王权[6] 燕速[7] 杨力 靖昌庆[9] 余江[10] 宋武[11] 臧潞[12] 邢加迪[13] 胡文庆 刘凤林[15] You Jun;Niu Zhaojian;Fan Lin;Wang Kuan;Zhao Yongliang;Wang Quan;Yan Su;Yang Li;Jing Changqing;Yu Jiang;Song Wu;Zang Lu;Xing Jiadi;Hu Wenqing;Liu Fenglin(Department of Gastrointestinal Oncology Surgery,the First Affiliated Hospital of Xiamen University,Xiamen 361003,Fujian Province,China;Department Gastrointestinal Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266000,Shangdong Province,China;Department of General Surgery,the First Affliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Gastrointestinal Surgery,Harbin Medical University Cancer Hospital,Harbin 150081,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of General Surgery,the First Affiliated Hospital of Jilin University,Changchun 130021,China;Department of Gastrointestinal Oncology Surgery,the Affiliated Hospital of Qinghai University,Xining 810001,China;Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of General Surgery,Shandong Provincial Hospital,Jinan 250021,China;Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Gastrointestinal Surgery,Peking University Cancer Hospital,Beijing 100142,China;Department of General Surgery,Changzhi People's Hospital,Changzhi,046099,Shanxi Province,China;Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]厦门大学附属第一医院胃肠肿瘤外科,厦门3361003 [2]青岛大学附属医院胃肠外科,青岛2266000 [3]西安交通大学第一附属医院普通外科,西安710061 [4]哈尔滨医科大学附属肿瘤医院胃肠外科,哈尔滨150081 [5]陆军军医大学第一附属医院胃肠外科,重庆400038 [6]吉林大学第一医院普通外科,长春130021 [7]青海大学附属医院胃肠肿瘤外科,西宁810001 [8]南京医科大学第一附属医院普通外科,南京京210029 [9]山东省立医院普通外科,济南250021 [10]南方医科大学南方医院普通外科,广州510515 [11]中山大学附属第一医院胃肠外科,广州510080 [12]上海交通大学医学院附属瑞金医院普通外科,上海200025 [13]北京大学肿瘤医院胃肠肿瘤中心,北京100142 [14]长治市人民医院普通外科,长治046099 [15]复旦大学附属中山医院普通外科,上海200032

出　　处：《中华消化外科杂志》2023年第3期355-362,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82172803)。

摘　　要：目的探讨腹腔镜近端胃切除术治疗近端胃癌和食管胃结合部腺癌的安全性和近期疗效。方法采用回顾性队列研究方法。收集2014年1月至2022年3月我国厦门大学附属第一医院等15家医学中心收治的385例行近端胃切除术治疗近端胃癌和食管胃结合部腺癌患者的临床病理资料;男304例,女81例;年龄为(63±9)岁。385例患者中,335例行腹腔镜近端胃切除术,设为腹腔镜组;50例行开腹近端胃切除术,设为开腹组。观察指标:(1)术中及术后情况。(2)随访情况。(3)分层分析。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Wilcoxon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。重复测量数据采用重复测量方差分析。结果(1)术中及术后情况。腹腔镜组患者手术时间,消化道重建(食管胃吻合、食管空肠吻合),术后病理学分期(0~Ⅰ期、Ⅱ~Ⅲ期),术后住院时间,术后早期并发症分别为(212±96)min,270、65例,177、107例,10(8~14)d,40例,其中术后病理学分期缺失51例患者资料;开腹组患者上述指标分别为(174±90)min,39、11例,22、28例,10(8~18)d,10例;两组患者手术时间、术后病理学分期比较,差异均有统计学意义(t=2.62,χ^(2)=5.93,P<0.05);消化道重建、术后住院时间、术后早期并发症比较,差异均无统计学意义(χ^(2)=0.19,Z=0.40,χ^(2)=2.50,P>0.05)。(2)随访情况。385例患者中,202例完成术后12个月随访,其中腹腔镜组、开腹组分别为187、15例。腹腔镜组患者发生反流性食管炎、食管吻合口狭窄分别为48、11例,开腹组患者上述指标分别为5、2例;两组患者上述指标比较,差异均无统计学意义(P>0.05)。腹腔镜组患者术后6个月和术后12个月体质量指数(BMI)、血红蛋白(Hb)、白蛋白(Alb)分别为(21±3)kg/m^(2)、(130±15)g/L、(40±4)g/L和(21±3)kg/m^(2)、(132±14)g/L、(Objective To investigate the safety and short-term efficacy of laparoscopic pro-ximal gastrectomy(LPG)for proximal gastric cancer and adenocarcinoma of esophagogastric junction.Methods The retrospective cohort study was conducted.The clinicopathological data of 385 patients with proximal gastric cancer and adenocarcinoma of esophagogastric junction who underwent LPG in the 15 medical centers,including the First Affiliated Hospital of Xiamen University et al,from January 2014 to March 2022 were collected.There were 304 males and 81 females,aged(63±9)years.Of the 385 patients,335 cases undergoing LPG were divided into the laparoscopic group and 50 cases undergoing open proximal gastrectomy were divided into the open group.Observation indicators:(1)intraoperative and postoperative situations;(2)follow-up;(3)stratified analysis.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was conducted using the Wilcoxon rank sum test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Repeated measurement data were analyzed using the repeated ANOVA.Results(1)Intraoperative and postoperative situations.The operation time,cases with reconstruction of digestive tract as esophagogastric anastomosis and esophageal-jejunal anastomosis,cases with postoperative pathological staging as stage 0-Ⅰand stageⅡ-Ⅲ,duration of postoperative hospital stay,cases with postoperative early complications were(212±96)minutes,270,65,177,107,10(range,8-14)days,40 in patients of the laparoscopic group,with 51 cases missing the data of postoperative pathological staging.The above indicators were(174±90)minutes,39,11,22,28,10(range,8-18)days,10 in patients of the open group.There were significant differences in the opera-tion time and postoperative pathological staging between

关 键 词：胃肿瘤 近端胃切除术 消化道重建 抗反流 食管胃吻合 食管空肠吻合 近期疗效 腹腔镜检查 

分 类 号：R735[医药卫生—肿瘤]