分隔式胃空肠吻合术联合远端选择性迷走神经离断术治疗良性胃出口梗阻的安全性及疗效研究  

Safety and efficacy of stomach-partitioning gastrojejunostomy with distal selective vagotomy for treating benign gastric outlet obstruction

作　　者：张海翘 王子萌 薛雅圣 王鈢 郑智[1] 刘小野[1] 尹杰[1] 张军[1] Zhang Haiqiao;Wang Zimeng;Xue Yasheng;Wang Xi;Zheng Zhi;Liu Xiaoye;Yin Jie;Zhang Jun(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普外科,北京100050

出　　处：《国际外科学杂志》2024年第9期616-622,F0003,共8页International Journal of Surgery

基　　金：北京市自然科学基金资助(7232334);国家自然科学基金资助(82300646)。

摘　　要：目的探究分隔式胃空肠吻合术(SPGJ)联合远端选择性迷走神经离断术(DSV)治疗良性胃出口梗阻(GOO)的围手术期安全性及术后近远期疗效。方法回顾性分析2019年1月—2023年7月首都医科大学附属北京友谊医院诊治的26例良性GOO患者的病例资料,其中男性20例(76.9%),女性6例(23.1%),年龄25~75岁,平均年龄(55.8±13.6)岁,平均体重指数(20.1±3.4)kg/m^(2),SPGJ联合DSV组12例,SPGJ组14例。主要观察指标为两组术后1年的胃肠道生活质量指数(GIQLI)生活质量评分。正态分布的连续性变量组间比较采用独立样本t检验进行差异性检验,非正态分布的连续性变量组间比较采用Mann-Whitney U检验进行差异性检验,计数资料比较采用χ^(2)检验或Fisher精确检验。结果SPGJ联合DSV组与SPGJ组在手术时间(P=0.071)、术中出血量(P=0.422)、术后首次排气时间(P=0.538)、术后首次进食时间(P=0.386)、术后住院时间(P=0.431)、术后30 d内并发症(P=0.999)、术后胃出口梗阻评分系统分级(P=0.483)方面,差异均无统计学意义。两组各有1例患者术后出现胃排空延迟,均为A级。随访结果显示,与SPGJ组相比,SGPJ联合DSV组在GIQLI评分方面具有显著优势,差异具有统计学意义(P=0.028)。SPGJ联合DSV组术后1年的胃溃疡、反流性食管炎、胆汁反流和胃炎发病率分别为8.3%、8.3%、8.3%、58.3%,而SPGJ组分别为35.7%和21.4%、21.4%、57.1%,但组间差异均无统计学意义。结论SPGJ联合DSV在治疗良性GOO未显著增加腹腔镜下操作难度、手术时间和术中出血量,且在术后1年的胃肠道生活质量方面具有显著优势。此外,SPGJ联合DSV术后1年的胃溃疡和反流性食管炎发病率较低,但仍需大样本的研究进一步证实。Objective To explore the perioperative safety and postoperative short-and long-term efficacy of stomach-partitioning gastrojejunostomy(SPGJ)with distal selective vagotomy(DSV)for treating benign gastric outlet obstruction(GOO).Methods The clinical data of 26 benign GOO patients treated by Beijing Friendship Hospital,Capital Medical University from January 2019 to July 2023 were retrospectively analyzed.There were 20 males(76.9%)and 6 females(23.1%),aged from 25 to 75 years,with an average age of(55.8±13.6)years,and an average body mass index(BMI)of(20.1±3.4)kg/m^(2).There were 12 cases in SPGJ-DSV group and 14 cases in SPGJ group.The main outcome was the gastrointestinal quality of life index(GIQLI)1 year after surgery in both groups.Independent sample t-test was used to test the difference between the continuous variables with normal distribution.The comparison between groups of non-normal distribution continuous variables was tested by Mann-Whitney U test.Counting data were compared using Chi-square test or Fisher exact test.Results There were no significant differences between the two groups in terms of operative time(P=0.071),intraoperative blood loss(P=0.422),time to pass gas(P=0.538),time to liquid intake(P=0.386),postoperative hospitalization(P=0.431),complications within 30 days after surgery(P=0.999),and postoperative GOOSS grade(P=0.483).Among them,postoperative DGE occurred in one patient in each of the two groups,both of which were grade A.In the follow-up results,compared with the SPGJ group,SPGJ-DSV group had a significant advantage in GIQLI score,and the difference was statistically significant(P=0.028).The incidence of gastric ulcer,reflux esophagitis,bile reflux and gastritis in SPGJ-DSV group was 8.3%,8.3%,8.3%and 58.3%,while that in SPGJ group was 35.7%,21.4%,21.4%and 57.1%,respectively,but there was no statistical significance between groups.Conclusion In the treatment of benign GOO patients,SPGJ with DSV did not significantly increase the difficulty of laparoscopic procedures,operative time

关 键 词：胃出口梗阻 十二指肠溃疡 消化系统外科手术 迷走神经切断术 生活质量 

分 类 号：R656.6[医药卫生—外科学]