近端胃切除术后两种消化道重建方式的安全性及生活质量对比研究

Comparative study on the safety of proximal gastrectomy by using two types digestive tract reconstruction and on the quality of life of patients after surgery

目的探究近端胃切除术后单、双通道间置空肠吻合重建的安全性及生活质量的影响。方法回顾性分析2016年9月至2019年1月行近端胃切除+间置空肠吻合术的57例早期近端胃癌患者资料。根据术中是否阻断空肠-空肠吻合口与胃-空肠吻合口间的肠管,将其分为单通道组(n=26,行单通道间置空肠吻合)和双通道组(n=31,行双通道间置空肠吻合)。采用统计软件SPSS 20.0进行数据分析,围术期指标、营养指标、生活质量评分等采用(±s)表示,独立样本t检验;术后并发症组间比较采用χ^2检验;反流性食管炎分级、TNM分期采用秩和检验。P<0.05为差异有统计学意义。结果两组在术时、出血量、通气时间、住院时间、术后并发症总发生率及反流性食管炎总发生率等方面差异均无统计学意义(P>0.05);术后1个月单通道组体重高于双通道组(P<0.05);术后6个月单通道组各营养指标均高于双通道组(P<0.05);两组患者术后各时间点功能状态评分及总体健康状况评分差异均无统计学意义(P>0.05)。结论近端胃癌切除术后行单、双通道间置空肠吻合均安全可行,但单通道吻合术后患者恢复状况优于双通道吻合。

Objective To investigate the safety of proximal gastrectomy by using two types digestive tract reconstruction and to compare the quality of life of patients after surgery.Methods From September 2016 to January 2019,clinical data of 57 patients with early staging gastric cancer,who underwent proximal gastrectomy plus interposition jejunostomy,were analyzed retrospectively.According to different type of reconstruction,patients were divided into the single-channel group(n=26,single-channel interposition jejunum anastomosis)and into the double-channel group(n=31,double-channel interposition jejunum anastomosis).Statistical analysis were performed by using SPSS20.0 software.Measurement data such as perioperative indicators,nutritional indicators and quality of life scores were represented as(±s)and were examined by using independent t test.Postoperative complications were analyzed by usingχ^2 test.Kaplan-meier method was used for survival analysis.The rank sum test were used for the reflux esophagitis grade and TNM stage.A P value of<0.05 was considered as statistical significant difference.Results There were no significant differences between two groups in terms of operation time,blood loss,ventilation time,hospital stay,total incidence of postoperative complications and total incidence of reflux esophagitis(P>0.05).The body weight of patients in the single channel group was significantly higher than those in the double channel group one month after surgery(P<0.05).The nutritional indexes in the single channel group were better than those in the double channel group(P<0.05).There was no significant difference in terms of functional status score and overall health status score at each postoperative time point between two groups(P>0.05).Conclusion It is safe and feasible to perform single or double channel interposition Jejunostomy after resection of proximal gastric cancer,however the recovery status of patients after single channel anastomosis is better than that after double channel anastomosis.