摘要
目的:对比分析改良食管胃侧壁吻合术(mSOFY)与管状胃食管吻合术在腹腔镜下近端胃切除消化道重建中应用的临床疗效。方法:回顾分析2022年1月至2023年6月采用腹腔镜近端胃切除mSOFY吻合与管状胃食管吻合治疗胃上部癌患者的临床资料,采取Logistic回归模型对两组患者基线资料进行1∶2倾向性评分匹配,对比分析两组术前、术中及术后相关指标。结果:mSOFY组纳入16例(A组),管状胃食管吻合组纳入25例(B组),两组患者一般资料差异均无统计学意义。两组手术时间、术中出血量、短期并发症差异均无统计学意义。A组反流性食管炎发生率低于B组(6.25%vs.40.00%,P=0.044)。根据洛杉矶分级,A组术后反流性食管炎的严重程度低于B组(P=0.022);A组Visick分级及术后胃食管反流病问卷量表评分更低(P<0.05)。术后6个月内,A组总蛋白、血清白蛋白、血清前白蛋白、血红蛋白、淋巴细胞计数、总胆固醇水平均高于B组(P<0.05),进食次数少于B组(P=0.015)。结论:mSOFY吻合术在预防术后胃食管反流、改善患者长期营养状况方面具有明显优势,是安全、有效的近端胃切除消化道重建方式,值得临床推广。
Objective:To compare and analyze the clinical efficacy of modified side overlap with fundoplication by Yamashita(mSOFY)versus tubular gastroesophageal anastomosis in digestive tract reconstruction following laparoscopic proximal gastrectomy.Methods:Retrospective analysis was conducted on the clinical data of patients with upper gastric cancer who underwent laparoscopic proximal gastrectomy with either mSOFY anastomoses or tubular gastroesophageal anastomoses between Jan.2022 and Jun.2023.A 1∶2 propensity score matching was performed using a logistic regression model to balance baseline characteristics between the two groups.Preoperative,intraoperative,and postoperative outcomes were analyzed and compared between the two groups.Results:Sixteen patients were included in the mSOFY group(Group A)and 25 patients in the tubular gastroesophageal anastomosis group(Group B).No significant differences were observed in baseline data between the two groups.There were no statistically significant differences in operative time,intraoperative blood loss,or short-term complications between the two groups.However,the postoperative incidence of reflux esophagitis was significantly lower in group A than in group B(6.3%vs.40.00%,P=0.044).According to the Los Angeles scale,the s everity of postoperative reflux esophagitis was milder in group A(P=0.022).Group A exhibited lower Visick grades and postoperative gastroesophageal reflux disease questionnaire scores.At 6 months postoperatively,group A exhibited significantly higher levels of total protein,serum albumin,serum prealbumin,hemoglobin,lymphocyte count,and total cholesterol compared to the group B(P<0.05),and required fewer daily meals than Group B(P=0.015).Conclusions:The mSOFY anastomosis demonstrates significant advantages in preventing postoperative gastroesophageal reflux and improving long-term nutritional status.It is a safe and effective technique for digestive tract reconstruction after proximal gastrectomy and warrants clinical adoption.
作者
代德柱
高梓豪
宋旭东
丁凡
张成功
韩笑
施亮
陶国全
DAI Dezhu;GAO Zihao;SONG Xudong(Department of Gastrointestinal Surgery,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University,Huai'an 223300,China)
出处
《腹腔镜外科杂志》
2025年第6期425-433,共9页
Journal of Laparoscopic Surgery
基金
国家自然科学基金(81773538)
Jiangsu Provincial Medical Key Discipline Cultivation Unit(JSDW202233)。
关键词
胃肿瘤
近端胃切除术
腹腔镜检查
改良食管胃侧壁吻合
管状胃食管吻合
Stomach neoplasms
Proximal gastrectomy
Laparoscopy
Modified side overlap with fundoplication by Yamashita anastomosis
Tubular gastroesophageal anastomosis
