摘要
目的对比分析食管胃结合部癌(AEG)完全腹腔镜全胃切除术(TLTG)中不同消化道重建方案的临床效果。方法选取2019年1月至2021年5月接受TLTG治疗的126例AEG患者作为研究对象,采用随机数字表法将患者分为π形组、Overlap组和双通道组,每组各42例。三组均行TLTG,π形组采用π形吻合,Overlap组采用食管空肠顺蠕动侧侧吻合(Overlap吻合),双通道组采用双通道空肠间置吻合。数据应用软件SPSS 22.0处理,患者围手术期相关指标等计量资料采用(x^(-)±s)表示,多组间比较行单因素方差分析,两组间比较行LSD-t检验,组内比较行配对t检验;患者术后并发症情况等计数资料采用[例(%)]表示,等级计数资料行秩和检验,非等级计数资料行χ^(2)检验。P<0.05表示差异有统计学意义。结果三组患者手术时间、术中出血量、淋巴结清扫数目、吻合时间、首次排气时间、首次进食时间、下床活动时间及术后住院时间等围手术期指标比较,差异无统计学意义(P>0.05)。三组患者术后均出现了不同程度的并发症,三组患者术后并发症的总发生率比较差异无统计学意义(P>0.05);但双通道组患者术后并发症总发生率显著低于π形组(28.6%vs.9.5%),差异有统计学意义(P<0.05)。三组患者术后6个月血清血红蛋白(Hb)、总蛋白(TP)、白蛋白(ALB)及体重指数(BMI)等营养指标较术前均显著降低(P<0.05),其中双通道组患者各营养指标均明显高于π形组和Overlap组(P<0.05)。中位随访时间28个月,通过Kaplan-Meier分析显示,三组患者累积总生存率(71.4%vs.76.2%vs.78.6%)及累积无病生存率(69.0%vs.73.8%vs.76.2%)比较,差异均无统计学意义(Log-Rankχ^(2)=1.007、1.058,P=0.604、0.589)。结论TLTG中3种消化道重建方式均是安全可行的,且预后相当。而双通道空肠间置吻合不仅可有效减少术后并发症的发生,还更有利于患者术后营养恢复,其优势更为明显,更值得临床推广应用。
Objective To compare and analyze the clinical effects of different digestive tract reconstruction schemes in total laparoscopic gastrectomy(TLTG)for esophagogastric junction cancer(AEG).Methods A total of 126 patients with AEG who received TLTG treatment from January 2019 to May 2021 were selected as research objects,and the patients were divided intoπshape group,Overlap group and double-channel group by random number table method,with 42 cases in each group.TLTG was performed in all the three groups.πshape group adoptedπshape anastomosis,Overlap group adopted esophagojejunal preperistaltic lateral anastomosis(Overlap),double-channel group adopted double-channel jejunal interposition anastomosis.The data were processed by SPSS 22.0,and the measurement data of perioperative indicators were expressed by(x^(-)±s).One-way ANOVA of variance was performed for comparison between multiple groups,LSD-t test was performed for comparison between two groups,and paired t test was performed for comparison within groups.The adoption rate(%)of counting data such as postoperative complications was indicated by Rank Sum test for rank counting data andχ^(2) test for non-rank counting data.P<0.05 indicated statistically significant difference.Results There was no significant difference in perioperative indexes among the three groups,such as operation time,intraoperative blood loss,number of lymph node dissection,anastomosis time,first exhaust time,first feeding time,getting out of bed time and postoperative hospitalization time(P>0.05).Postoperative complications occurred in all the three groups,and there was no statistical significance in the total incidence of postoperative complications among the three groups(P>0.05).However,the total incidence of postoperative complications in the dual-channel group was significantly lower than that in theπ-shaped group(28.6%vs.9.5%),and the difference was statistically significant(P<0.05).Six months after operation,nutritional indexes such as hemoglobin(Hb),total protein(TP),albumin(ALB)and body mass index(BMI)in the three groups were significantly decreased compared with those before operation(P<0.05),and nutritional indexes in the two-channel group were significantly higher than those inπshape group and Overlap group(P<0.05).Median follow-up time was 28 months.Kaplan-Meier analysis showed that cumulative overall survival(71.4%vs.76.2%vs.78.6%)and cumulative disease-free survival(69.0%vs.73.8%vs.76.2%)were compared among the three groups.There was no significant difference(Log-Rankχ^(2)=1.007,1.058,P=0.604,0.589).Conclusion The three methods of digestive tract reconstruction in TLTG are safe and feasible,and the prognosis is similar.Double-channel jejunal interposition anastomosis can not only effectively reduce the occurrence of postoperative complications,but also be more conducive to postoperative nutritional recovery of patients,and its advantages are more obvious,which is worthy of clinical application.
作者
戴文鹏
邱卫明
王克强
罗来斌
徐志敏
黄湖南
车河龙
Dai Wenpeng;Qiu Weiming;Wang Keqiang;Luo Laibin;Xu Zhimin;Huang Hunan;Che Helong(Department of General Surgery,No.908 Hospital of Joint Service Support Force of Chinese People’s Liberation Army,Yingtan Jiangxi Province 335000,China)
出处
《中华普外科手术学杂志（电子版）》
2023年第3期300-304,共5页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
关键词
食管胃结合处
腺癌
全腹腔镜
胃切除术
消化道重建
Esophagogastric Junction
Adenocarcinoma
Total Laparoscopic
Gastrectomy
Digestive Tract Reconstruction
