SiewertⅡ型食管胃结合部腺癌根治性切除全腹腔镜Overlap吻合与腹腔镜辅助端侧吻合的短期安全性比较:多中心回顾性队列研究  

Comparison of short-term safety of two anastomotic techniques when resecting Siewert type Ⅱ adenocarcinoma of the esophagogastric junction: a multicenter retrospective cohort study

作　　者：周海鲲 高晓鹏 时飞宇 王靖宇 杨秦川 李世森 柳金强 纪盼盼 王伟东 余鹏飞 高瑞祺 郭欣 季刚 卫江鹏 Zhou Haikun;Gao Xiaopeng;Shi Feiyu;Wang Jingyu;Yang Qinchuan;Li Shisen;Liu Jinqiang;Ji Panpan;Wang Weidong;Yu Pengfei;Gao Ruiqi;Guo Xin;Ji Gang;Wei Jiangpeng(Gastrointestinal Surgery Department,the First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032,China;Gastrointestinal Surgery Department,Yuncheng Central Hospital,Yuncheng 044000,China;Department of General Surgery,High Talent Laboratory,the First Affiliated Hospital of Xi'an Jiaotong University,Center for Gut Microbiome Research,Med-X Institute,Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]空军军医大学第一附属医院胃肠外科,西安710032 [2]山西省运城市中心医院胃肠外科,运城044000 [3]西安交通大学第一附属医院普通外科,西安710061

出　　处：《中华胃肠外科杂志》2024年第1期47-53,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：陕西省创新能力支撑计划-科技创新团队项目(2021TD-43)。

摘　　要：目的比较Siewert Ⅱ型食管胃结合部腺癌根治性切除后全腹腔镜Overlap吻合与腹腔镜辅助端侧吻合两种消化道重建方式的短期安全性。方法本研究采用回顾性队列研究的方法。其中空军军医大学第一附属医院2021年11月至2023年7月收治89例、西安交通大学第一附属医院2020年12月至2021年6月期间收治36例和山西省运城市中心医院2021年9月至2022年11月期间收治14例, 共计139例行根治性手术切除的SiewertⅡ型食管胃结合部腺癌患者临床资料纳入分析。全组男性107例(77.0%), 女性32例(23.0%);年龄(62.5±9.3)岁。48例行全腹腔镜Overlap吻合(Overlap吻合组), 91例行腹腔镜辅助端侧吻合(端侧吻合组)。比较两组患者的临床资料、手术信息、病理结果、术后恢复情况及相关并发症发生情况。结果 Overlap吻合组与端侧吻合组患者的一般临床资料比较差异无统计学意义(均P>0.05), 两组具有可比性。Overlap吻合组与端侧吻合组的手术时间比较, 差异无统计学意义[(267.2±60.1)min比(262.8±70.6)min, t=0.370, P=0.712], 但Overlap吻合组的术中出血量更少[100(50, 100)ml比100(50, 175)ml, Z=2.776, P=0.005]。与端侧吻合组比较, Overlap吻合组可获得更长的肿瘤距离上切缘[(1.7±1.0)cm比(1.3±0.9)cm, t=2.487, P=0.014], 更长的肿瘤距离下切缘[(9.5±2.9)cm比(7.9±3.5)cm, t=2.667, P=0.009]。与端侧吻合组比较, Overlap吻合组患者术后首次下床活动时间更早[1.0(1.0, 2.0)d比2.0(1.0, 3.0)d, Z=3.117, P=0.002], 首次饮水时间更早[(4.7±2.6)d比(6.2±3.0)d, t=2.851, P=0.005], 首次进食时间更早[(6.0±2.7)d和(7.1±3.0)d, t=2.170, P=0.032], 差异均有统计学意义(均P<0.05);但住院费用较高[(113 105.5±37 766.3)元比(97 250.2±27 746.9)元], 差异有统计学意(t=2.818, P=0.006)。两组术后住院时间、清扫淋巴结总数及术后首次排气时间比较, 差异均无统计学意义(均P>0.05)。Overlap吻合组与端侧吻合组手术�Objective In this study,we aimed to compare the short-term safety of two digestive tract reconstruction techniques,laparoscopic total abdominal overlap anastomosis and laparoscopic-assisted end-to-side anastomosis,following radical resection of Siewert Type Ⅱ adenocarcinoma of the esophagogastric junction.Methods In this retrospective cohort study,we analyzed relevant clinical data of 139 patients who had undergone radical surgery for Siewert Type Ⅱ esophagogastric junction adenocarcinoma.These included 89 patients treated at the First Affiliated Hospital of Air Force Medical University from November 2021 to July 2023,36 patients treated at the First Affiliated Hospital of Xi'an Jiaotong University from December 2020 to June 2021,and 14 patients treated at the Yuncheng Central Hospital in Shanxi Province from September 2021 to November 2022.The group consisted of 107 men(77.0%)and 32 women(23.0%)of mean age 62.5±9.3 years.Forty-eight patients underwent laparoscopic total abdominal overlap anastomosis(overlap group),and 91 laparoscopic-assisted end-to-side anastomosis(end-to-side group).Clinical data,surgical information,pathological findings,postoperative recovery,and related complications were compared between the two groups.Results There were no significant differences in general clinical data between the overlap and end-to-side anastomosis groups(all P>0.05),indicating comparability.There was no significant difference in operation time(267.2±60.1 minutes vs.262.8±70.6 minutes,t=0.370,P=0.712).However,the intraoperative blood loss in the overlap group(100[50,100]mL)was significantly lower compared to the end-to-side group(100[50,175]mL,Z=2.776,P=0.005).Compared to the end-to-side group,longer distances between the tumor and distal resection margin proximal(1.7±1.0 cm vs.1.3±0.9 cm,t=2.487,P=0.014)and the tumor and distal resection margin(9.5±2.9 cm vs.7.9±3.5 cm,t=2.667,P=0.009)were achieved in the overlap group.Compared with the end-to-side group,the overlap group achieved significantly earlier post

关 键 词：食管胃结合部肿瘤 胃癌根治术 腹腔镜 食管空肠吻合术 

分 类 号：R735[医药卫生—肿瘤]