改良管状胃-食管吻合术在腹腔镜近端胃切除消化道重建中的安全性及抗反流效果研究  

Safety and anti-reflux effect of modified tubular gastro-esophagostomy in laparoscopic proximal gastrectomy for gastrointestinal reconstruction

作　　者：李贞贞[1] 王宏刚[1] 崔丽丽[1] 缪月琴[1] 刘万璐 Li Zhenzhen;Wang Honggang;Cui Lili;Miu Yueqin;Liu Wanlu(Taizhou People's Hospital Taizhou,Taizhou Jiangsu Province 225300,China)

机构地区：[1]江苏省泰州市人民医院,江苏泰州225300

出　　处：《中华普外科手术学杂志(电子版)》2025年第2期176-179,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：江苏省卫生健康委科研项目(M2020084)。

摘　　要：目的研究改良管状胃-食管吻合术在腹腔镜近端胃切除消化道重建中的安全性及抗反流效果。方法回顾性分析2022年1月至2023年12月107例行腹腔镜近端胃切除术患者的临床资料,依据消化道重建方法不同分为2组,接受单纯食管残胃吻合术的52例患者为对照组,采用管状胃-食管吻合术的55例患者为观察组。应用SPSS 27.0软件分析数据。围手术期指标和胃食管反流病量表(Gerd Q)评分等计量资料用(x±s)表示,行独立样本t检验;术后并发症总发生率比较行χ^(2)检验,并发症Clavien-Dindo分级比较行Z检验。P<0.05为差异有统计学意义。结果观察组患者手术时间、吻合时间、并发症Clavien-Dindo分级与对照组相比,差异无统计学意义(P>0.05);首次饮水时间、胃管平均每日引流量等指标较对照组明显改善(P<0.05);术后6个月内并发症总发生率低于对照组(5.5%vs.30.8%,P<0.05);术后7d,观察组患者Gerd Q量表评分低于对照组(P<0.05),观察组术后营养指标血红蛋白(HB)、白蛋白(ALB)、身体质量指数(BMI)均优于对照组(P<0.05);术后6~9个月,观察组有4例,对照组有16例患者出现轻度反流症状,所有患者体重浮动范围为术前体重的4%~5%,饮食基本恢复正常。结论腹腔镜端胃切除术的患者,管状胃-食管吻合术可改善围手术期指标,降低并发症发生风险,缓解胃食管反流症状,提升营养状况。Objective To investigate the safety and anti-reflux effect of modified tubular gastroesophagostomy in laparoscopic proximal gastrectomy for gastrointestinal reconstruction.Methods The clinical data of 107 patients who underwent laparoscopic proximal gastrectomy from January 2022 to December 2023 were retrospectively analyzed and divided into 2 groups according to different methods of digestive tract reconstruction.52 patients who received simple esophagostomy were used as control group,and 55 patients who received tubular gastro-esophagostomy were used as observation group.SPSS 27.0 software was used to analyze the data.Measurement data such as perioperative indexes and Gerd Q scores were represented by(±s),and independent sample t test was performed.The total incidence of postoperative complications was compared byχ^(2)test,and the Clavien-Dindo classification of complications was compared by Z test.P<0.05 was considered statistically significant.Results There was no significant difference in operation time,anastomosis time and Clavien-Dindo grade of complications between observation group and control group(P>0.05).Compared with the control group,the indexes of first drinking time and average daily flow of gastric tube were significantly improved(P<0.05).The total complication rate within 6 months after operation was lower than that of control group(5.5%vs.30.8%,P<0.05).7 days after surgery,Gerd Q scale score of observation group was lower than that of control group(P<0.05),postoperative nutritional indexes hemoglobin(HB),albumin(ALB)and body mass index(BMI)of observation group were better than those of control group(P<0.05);6 to 9 months after surgery,there were 4 patients in the observation group and 16 patients in the control group with mild reflux symptoms.The weight of all patients fluctuated from 4%to 5%of their preoperative body weight,and their diet basically returned to normal.Conclusion In patients with laparoscopic end-gastrectomy,tubular gastroesophagostomy can improve perioperative indicators,redu

关 键 词：胃肿瘤 腹腔镜 胃切除术 管状胃-食管吻合 手术后并发症 

分 类 号：R73[医药卫生—肿瘤]