早期近端胃癌行腹腔镜辅助下近端胃切除双通路吻合术的短期手术疗效观察

Short-term surgical outcomes of laparoscopic-assisted proximal gastrectomy with double channel digestive tract reconstruction for early proximal gastric cancer*

摘要:

摘要：目的??为评估早期近端胃癌保功能手术的可行性与益处，比较早期胃癌患者行腹腔镜辅助近端胃切除双通道吻合术与腹腔镜辅助全胃切除Roux-en-Y消化道重建术的短期手术效果。方法?选取2016年5月－2018年5月29例早期近端胃癌患者接受近端胃切除双通道吻合术；同时选取该院2015年6月以来行全胃切除Roux-en-Y消化道重建术的早期近端胃癌患者，做人口统计学信息、合并症、肿瘤特征和TNM分期配对，对两组患者的围术期和短期手术结果进行比较。结果?两组患者的术后病理学特征相近，两组患者均无中转开腹及均未出现术中并发症，两组患者手术时间、术中出血量、术后肛门首次排气时间、首次进食时间及术后住院时间比较，差异均无统计学意义，双通道组淋巴结清扫量（16.73±5.68）枚明显少于全胃切除组（21.43±4.09）枚，两组比较，差异有统计学意义（P =0.023）。每组患者均无吻合口瘘、吻合口出血、反流性食管炎、切口感染及淋巴瘘的记录，两组患者并发症发生率和围术期炎症反应比较，差异无统计学意义。术后随访3个月发现，较之全胃切除Roux-en-Y消化道重建术患者，近端胃切除双通道吻合术患者生活满意度高，两组患者术后体重均较术前下降，其中全胃切除组患者术后体重下降较双通道组比例更高，两组比较，差异有统计学意义（P <0.05）；两组患者术前和术后1个月血红蛋白比较，差异无统计学意义，术后2和3个月随访结果显示，双通道组血红蛋白量较全胃切除组高，两组比较，差异有统计学意义（P <0.05）；在术前、术后1及2个月，两组患者的血清白蛋白量比较，差异无统计学意义，术后3个月时，双通道组患者血清白蛋白量（41.45±3.68）g/L明显高于全胃切除组（38.45±4.96）g/L，差异有统计学意义（P =0.035）。结论?早期近端胃癌行腹腔镜辅助下近端胃切除双通道吻合术有较好的可行性和安全性，近期疗效满意，与全胃切除组比较，双通路术式不增加围术期并发症的发生率，而患者术后营养状况更好，术后体重下降率更低。

Abstract:

Abstract: Objective?To evaluate the feasibility and benefits of functional surgery for early proximal gastric cancer, we compared short-term surgical outcomes between laparoscopic-assisted proximal gastrectomy with double channel digestive tract reconstruction (LAPGDC) and laparoscopic-assisted total gastrectomy with Roux-en-Y digestive tract reconstruction (LATGRY) for early proximal gastric cancer.?Methods?29 early proximal gastric cancer patients underwent attempted LAPGDC from May 2016 to May 2018. Patients who underwent attempted LATGRY after June 2015 were matched to LAPGDC cases for demographics, comorbidities, tumor characteristics, and TNM stage. Perioperative and short-term surgical outcomes were compared between the two groups.?Results?Clinicopathological characteristics of both groups were comparable. There were no conversions to laparotomy and intraoperative complications in the two groups. The operation time, intraoperative blood loss, postoperative first anal exhaust time, eating time and postoperative hospital stay were not statistically significant. The LAPGDC group had fewer number of lymph node dissection than that in the LATGRY group [(16.73 ± 5.68) vs (21.43 ± 4.09), P = 0.023]. There were no anastomotic leakage, anastomotic bleeding, reflux esophagitis, incision infection and lymphatic fistula in each group. There were no differences in the rates of perioperative complications and in inflammatory parameters between the two groups. Postoperative follow-up for 3 months, compared to LATGRY group, the LAPGDC group had a higher life satisfaction. The weight of the two groups decreased after operation compared with that before operation. The LATGRY group had a higher rate of weight loss than that in the LAPGDC group. The hemoglobin levels of the two groups were not statistically significant before and 1 month after the operation. At 1 month and 3 months after operation, the LAPGDC group had a higher hemoglobin level than that in the LATGRY group. The quantity of serum albumin of the two groups were not statistically significant before operation, 1 month after operation and 2 months after operation. The LAPGDC group had a higher level of serum albumin than that in the LATGRY group at 3 months after operation [(41.45 ± 3.68) vs (38.45 ± 4.96) g/L, P = 0.035].?Conclusion?This study suggests that LAPGDC is feasible with satisfactory short-term efficacy, compared to LATGRY, the incidence of perioperative complications was not increased, but that it has several advantages over LATGRY, including better postoperative nutritional status, lower rate of postoperative weight loss, and higher life satisfaction.