腹腔镜近端胃切除术中附加H-M幽门成形术与改良幽门肌切开术的近期疗效和生活质量对比研究  

A comparative study of short-term outcomes and quality of life between laparoscopic proximal gastrectomy with additional H-M pyloroplasty and modified pyloromyotomy

作　　者：茆阳 张海涛[1] 潘寅初 Mao Yang ;Zhang Haitao ;Pan Yinchu(General Surgery Department,the First Affiliated Hospital of Soochow University,Suzhou Jiangsu Province 215006,China)

机构地区：[1]苏州大学附属第一医院普外科,江苏苏州215006

出　　处：《中华普外科手术学杂志（电子版）》2024年第2期167-170,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：苏州市科学技术项目(WS202122)。

摘　　要：目的对比腹腔镜近端胃切除术(LPG)食管残胃吻合(EG)中离断迷走神经+H-M幽门成形术与改良幽门肌切开术的近期疗效和生活质量。方法选取2020年1月至2022年6月66例行LPG的近端胃癌(PGC)患者作为研究对象,采用随机数字表法将患者分为两组,每组各33例。两组均行腹腔镜近端胃切除术,采用食管残胃吻合。改良组术中行改良幽门肌切开术,传统组术中加H-M幽门成形术。数据应用软件SPSS 22.0处理,围手术期相关指标、术后生活质量等计量资料采用(x±s)表示,行独立样本t检验;术后并发症情况等计数资料采用[n(%)]表示,行χ^(2)检验。P<0.05为差异有统计学意义。结果两组患者手术时间、术中出血量、肠道功能恢复时间、胃管留置时间、术后住院时间、术后GCSI评分比较,差异均无统计学意义(P>0.05)。两组患者术后腹腔感染、吻合口漏、吻合口出血、胃排空障碍等近期并发症及吻合口狭窄、幽门狭窄、胃潴留等远期并发症比较,差异均无统计学意义(P>0.05),而改良组患者术后胆汁反流的发生率显著低于传统组(6.7%vs.30.3%,P<0.05)。随访期间,改良组患者胃食管反流量表(Gerd Q)评估总分较传统组显著降低,Chew-wun Wu特殊症状量表评估总分显著升高(P<0.05),且Chew-wun Wu量表评分结果显示,改良组在饮食量、饮食次数、饭后腹胀及胃灼热感上的评分均显著高于传统组(P<0.05)。结论与H-M幽门成形术相比,LPG中改良幽门肌切开术不仅降低了术后胆汁反流的发生,改善了患者术后胃食管反流症状,还提高了患者术后生活质量。Objective Compare the short-term efficacy and quality of life between laparoscopic proximal gastrectomy(LPG)esophagogastrostomy(EG)with vagal nerve transection and H-M pyloroplasty and modified pyloric myotomy.Methods A total of 66 patients with LPG proximal gastric cancer(PGC)admitted to our hospital from January 2020 to June 2022 were selected as research objects.The patients were divided into the improved group and the traditional group according to random number table,each of 33 cases.Esophagogastric stump anastomosis and vagus nerve dissection were used in both groups.MP was added in the improved group and HMP was added in the traditional group.The data were processed by SPSS 22.0 software.Perioperative indicators,postoperative quality of life and other measurement data were expressed by(x±s),and independent t-test was performed.Statistical data such as postoperative complications were represented by[n(%)]andχ^(2) test was performed.P<0.05 was considered statistically significant.Results There were no significant differences in operation time,intraoperative blood loss,intestinal function recovery time,indindent time of gastric tube,postoperative hospital stay and postoperative GCSI score between the two groups(P>0.05).There were no significant differences in postoperative abdominal infection,anastomotic leakage,anastomotic hemorrhage,gastric emptydisorder and long-term complications such as anastomotic stenosis,pyloric stenosis and gastric retention between the two groups(P>0.05).However,the incidence of postoperative bile reflux in the improved group was significantly lower than that in the traditional group(6.7%vs.30.3%,P<0.05).During the follow-up period,the total score of the gastroesophageal reflux scale(Gerd Q)in the improved group was significantly lower than that in the traditional group,and the total score of Chew-wun Wu was significantly increased(P<0.05).The scores of dietary quantity,dietary times,abdominal distension and stomach burning sensation in the improved group were significantly higher

关 键 词：胃肿瘤 胃切除术 近端 Heineke-Mikulicz幽门成形术 改良幽门肌切开术 腹腔镜 食管残胃吻合 

分 类 号：R735.2[医药卫生—肿瘤]