倾向性匹配评分分析腹腔镜辅助保留幽门胃切除术治疗早期胃中部癌的安全性和有效性  

Safety and efficacy of laparoscopy-assisted pylorus-preserving gastrectomy for early middle-third gastric cancer based upon propensity score matching

作　　者：倪博 朱纯超[1] 张子臻[1] Ni Bo;Zhu Chunchao;Zhang Zizhen(Department of Gastrointestinal Surgery,Affiliated Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200001,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200001

出　　处：《腹部外科》2024年第2期95-100,共6页Journal of Abdominal Surgery

基　　金：国家自然科学基金面上项目(82173215);国家自然科学基金青年项目(82303428)。

摘　　要：目的分析腹腔镜辅助保留幽门胃切除术(laparoscopy-assisted pylorus-preserving gastrectomy,LAPPG)治疗早期胃中部癌的安全性和有效性。方法利用倾向性匹配评分方法,回顾性收集2016年1月至2020年12月在上海交通大学医学院附属仁济医院胃肠外科接受腹腔镜辅助手术的早期胃中部癌病人的临床病理资料,并对病人的围手术期相关事件,包括一般情况、肿瘤病理特征、术中情况和术后恢复情况,及术后6个月的营养状况和胆汁反流性胃炎发生率进行分析。结果LAPPG组的手术时间比腹腔镜辅助远端胃切除术(laparoscopy-assisted distal gastrectomy,LADG)组稍长[(226.6±18.2)mins比(220.6±18.4)mins P<0.05]。LAPPG组术后6个月胆汁反流性胃炎的发生率较LADG组低(LAPPG组9.5%,LADG组33.6%,χ^(2)=19.99,P<0.01)。两组病人的淋巴结清扫数目[LAPPG组(20.4±6.1)个,LADG组(21.4±7.5)个]和术后住院时间[LAPPG组8(6~32)d,LADG组8(6~31)d]及相关恢复情况均无差异,且均符合诊疗指南要求。结论LAPPG是安全有效的手术方式,与LADG相比可有效降低胆汁反流性胃炎发生率。Objective To evaluate the safety and efficacy of laparoscopy-assisted pyloruspreserving gastrectomy(LAPPG)for early middle-third gastric cancer(GC).Methods From January 2016 to December 2020,the relevant clinicopathological data were retrospectively reviewed for patients with early middle-third GC undergoing LAPPG.Propensity score matching was employed.Perioperative events of general profiles,tumor pathological features,intraoperative findings and postoperative recovery were recorded.At Month 6 post-operation,nutritional status and the incidence of bile reflux gastritis(BRG)were examined.Results Operative duration was slightly longer in LAPPG group than that in laparoscopy-assisted distal gastrectomy(LADG)group[(226.6±18.2)vs(220.6±18.4)min].And the incidence of BRG was lower in LAPPG group than that in LADG group(9.5%vs 33.6%).No inter-group differences existed in count of dissected lymph nodes[(20.4±6.1)vs(21.4±7.5)],postoperative hospital stay[8(6-32)vs 8(6-31)day]or recovery period.Both accorded with the diagnostic and therapeutic guidelines.Conclusion Both safe and feasible,LAPPG has demonstrated no significant difference in perioperative safety and effectiveness as compared with LADG.And LAPPG may effectively prevent the long-term complications.

关 键 词：腹腔镜辅助保留幽门胃切除术 腹腔镜辅助远端胃大部切除术 安全性 有效性 倾向性匹配评分 

分 类 号：R656.6[医药卫生—外科学]