近端胃切除双通道重建与管状胃重建的临床疗效对比  

Double-tract vs gastric tube reconstruction after proximal gastrectomy in upper third gastric cancer

作　　者：赖垂林 顾奇偶 詹添 徐磊 张建平[1] LAI Chuilin;GU Jiou;ZHAN Tian;XU Lei;ZHANG Jianping(Department of General Surgery,The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学第二附属医院普外科,江苏南京210000

出　　处：《西部医学》2025年第4期574-578,共5页Medical Journal of West China

基　　金：国家自然基金面上项目(81874058)。

摘　　要：目的比较近端胃切除术(PG)术后双通道(DT)重建和管状(Tube)胃重建的手术结果和术后长期疗效。方法回顾性分析2010年1月—2022年1月在我院行胃切除术的患者,根据PG术后重建方法,将患者分为DT组和Tube组。经倾向评分匹配分析调整后,比较两组患者的手术结果、并发症、术后长期反流性食管炎和营养状况。结果经倾向评分匹配后,共纳入44例患者,Tube组和DT组各22例。两组患者术后并发症、住院天数、6个月血红蛋白、白蛋白下降率、6、12个月体重减轻情况比较,差异均无统计学意义(P>0.05)。与DT组比较,Tube组手术时间较短(P=0.007)。术后12个月,与Tube组比较,DT组Visick评分(P=0.012)和内镜下反流性食管炎发生率(P=0.002)明显降低。结论PG术后双通道重建与管状胃重建术后并发症及营养状况无显著性差异,管状胃重建可大大缩短手术时间,双通道重建更有效地预防术后食管反流。Objective To compare the surgical outcomes and long-term postoperative efficacy of double-tract reconstruction(DT)and gastric tube reconstruction(Tube)after proximal gastrectomy.Methods This study retrospectively reviewed patients who underwent gastrectomy from January 2010 to January 2022 in our hospital.According to the reconstruction method after PG,patients were divided into DT group and Tube group.After adjusting for propensity score matching analysis,we compared the surgical outcomes,complications,and postoperative long-term reflux esophagitis and nutritional status between the two groups.Results After propensity score matching had been done,a total of 44 patients were included in this analysis(22 patients in the Tube and DT groups respectively).There were no significance between the two groups in postoperative complications,days of postoperative hospital stay,hemoglobin and albumin decreasing rate at 6 months,and weight loss at 6 and 12 months.The operation time of Tube group was shorter(248.8 vs 296.1 min,P=0.007).The Visick score(P=0.012)and the rate of endoscopic reflux esophagitis(P=0.002)of DT group were significantly lower.Conclusion There is no significance in postoperative complications and nutritional status between double-tract and gastric tube reconstruction after PG.Tube reconstruction can greatly reduce the operation time,while double-tract is more effective in preventing postoperative esophageal reflux.

关 键 词：上三分之一胃癌 近端胃切除术 双通道 管状胃重建 倾向评分匹配 

分 类 号：R656.61[医药卫生—外科学] R735.2[医药卫生—临床医学]