近端胃切除术不同消化道重建方式临床疗效比较:一项多中心真实世界研究  

Comparison of the efficacy of different digestive tract reconstruction methods after proximal gastrectomy for gastric cancer:a multicenter real-world study

作　　者：黄勇 郑智[1] 徐凯[3] 王子健 杜永星 周传永 黄子杰 卢一鸣 张政[2] 刘娟[2] 张海翘 刘小野[1] 王鹏[5] 邵欣欣[5] 谢天宇 唐云 田艳涛[5] 张军[1] 蔡军[1] 苏向前[3] 张忠涛[1] 邢加迪[3] 钟宇新[5] 王鑫鑫 尹杰[1] HUANG Yong;ZHENG Zhi;XU Kai(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;不详)

机构地区：[1]首都医科大学附属北京友谊医院普通外科,北京100050 [2]首都医科大学附属北京友谊医院消化内科,北京100050 [3]北京大学肿瘤医院胃肠肿瘤中心,北京100142 [4]中国人民解放军总医院第一医学中心普通外科医学部,北京100853 [5]中国医学科学院肿瘤医院胰胃外科,北京100021

出　　处：《中国实用外科杂志》2024年第10期1144-1148,1154,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.82300646);北京市自然科学基金项目(No.7232334);北京市属医院科研培育项目(No.PX20240103,No.PX2020001);首都卫生发展科研专项项目(No.2024-2-2028);北京大学肿瘤医院临床研究青年基金项目(No.QNJJ2022019);北京市科委AI+健康协同创新培育项目(Z241100007724004)。

摘　　要：目的对比分析近端胃切除术不同消化道重建方式的临床疗效。方法回顾性分析2018年1月至2023年12月北京市4所大型三甲医院(首都医科大学附属北京友谊医院、北京大学肿瘤医院、中国医学科学院肿瘤医院、中国人民解放军总医院第一医学中心)收治的290例行根治性近端胃切除术病人的临床资料。消化道重建方式包括胃食管端侧吻合83例(端侧组),管状胃吻合74例(管胃组),双通道吻合54例(双通道组),食管残胃侧壁吻合56例(SOFY组),双肌瓣吻合23例(Kamikawa组)。比较各组围手术期指标、内镜下反流分级、营养状态指标以及随访和生存情况。随访时间截至2024年4月。结果各组间淋巴结转移数、二次手术率、≥Ⅲ级并发症发生率、围手术期病死率差异无统计学意义(P>0.05)。端侧组和SOFY组术中出血量高于其他组(P<0.05);管胃组术后胃管留置时间和住院时间明显长于其他组(P<0.05);Kamikawa组在淋巴结清扫数和术后并发症发生率方面明显优于其他组(P<0.05)。在术后病死率和复发率方面,端侧组和管胃组高于其他组(P<0.05)。术后B级及以上反流性食管炎发生率为31.1%,SOFY组和Kamikawa组在术后反流进展方面明显优于其他组(P<0.05)。术后1年,管胃组、SOFY组、Kamikawa组完成术后综合征估量表-45评估,在SF-8生活质量、生存状况和生活质量方面3组间差异无统计学意义(P>0.05),在胃肠道症状方面,Kamikawa组明显优于管胃组和SOFY组(P<0.05)。结论近端胃切除术不同消化道重建方式中,SOFY吻合和Kamikawa吻合具有相近的临床疗效且安全可行,在术后抗反流方面优于其他重建方式。Objective To compare the postoperative quality of life and efficacy of different digestive tract reconstruction methods after proximal gastrectomy.Methods A retrospective analysis was conducted on the clinicopathological data of 290 patients who underwent radical proximal gastrectomy at four centers from January 2018 to December 2023.Based on the reconstruction methods,the patients were divided into the following groups:83 cases in the Gastroesophageal End-to-Side Anastomosis group,74 cases in the Pouch Anastomosis group,54 cases in the Double Tract Anastomosis group,56 cases in the SOFY Anastomosis group,and 23 cases in the Kamikawa Anastomosis group.The observation indicators,including perioperative indicators,endoscopic reflux grading,nutritional status indicators,follow-up,and survival conditions,were compared between different groups.The follow-up period extends until April 2024.Results There were no statistically significant dfferences among the groups in terms of the number of lymph node metastases,reoperation rate,incidence of Grade Il and above complications,and perioperative mortality rate(P>0.05).The End-to-Side group and SOFY group had significantly higher intraoperative blood loss compared to the other groups(P<0.05).The Pouch group had significantly longer postoperative nasogastric tube retention days and hospital stays compared to the other groups(P<0.05).The Kamikawa group showed a significant increase in the number of lymph nodes dissected and a lower incidence of postoperative complications compared to the other groups(P<0.05).The End-to-Side group and Pouch group had higher postoperative mortality and recurrence rates compared to the other groups(P<0.05).The incidence of Grade B or higher reflux esophagitis was 31.1%.The SOFY group and Kamikawa group showed significantly less postoperative reflux progression compared to the other groups(P<0.05).One year after surgery,the Pouch group,SOFY group,and Kamikawa group completed PCSAS-45.There was no statistically significant difference in SF-8 qualit

关 键 词：胃癌 近端胃切除术 消化道重建 反流性食管炎 双肌瓣吻合 食管残胃侧壁吻合 生活质量 

分 类 号：R6[医药卫生—外科学]