改良Devine术在晚期不可切除远端胃癌中应用效果评价

Clinical evaluation of Modified Devine exclusion for patients with unresectable distal gastric cancer

目的探讨不同两种术式应用晚期不可切除远端胃癌患者的安全性及可行性。方法回顾性分析2012年9月至2019年9月期间行手术治疗的61例晚期远端不可切除胃癌患者的临床资料。其中25例行改良Devine术(改良组),36例行传统胃空肠吻合术(传统组)。采用SPSS 21.0统计软件包进行分析,围术期各项指标以(±s)表示,采用独立样本t检验;术后并发症比较采用χ^(2)检验;患者术后满意度比较采用U检验。P<0.05为差异有统计学意义。结果两组患者手术平均时间、失血量、术后通气时间,进食时间、住院时间及患者术后1个月白蛋白增加等指标,差异无统计学意义(P均>0.05)。传统组有6例(16.7%)发生了胃排空障碍,而改良组未发生胃排空障碍,差异有统计学意义(P=0.032);改良组术后总并发症发生率4.0%明显低于传统组22.2%,差异有统计学意义(P=0.048);改良组患者术后满意度明显高于传统组,差异有统计学意义(P=0.016)。结论改良Devine术可明显缓解症状,术后并发症低,患者满意度高是一种安全有效的手术方式,值得推广应用。

Objective To investigate the safety and feasibility of two different surgical methods for patients with unresectable distal gastric cancer.Methods Clinical data of 61 patients with unresectable distal gastric cancer who underwent surgical treatment from September 2012 to September 2019 were analyzed retrospectively.Among them,25 cases underwent modified Devine operation(modified group),and 36 cases underwent traditional gastrojejunostomy(traditional group).Statistical analysis were performed by using SPSS21.0 software package.The perioperative indicators were expressed as and were analyzed by using independent sample t-test.The postoperative complications were compared by usingχ^(2) test.The postoperative satisfaction of patients were compared by using Mann-Whitney U test.A P value of<0.05 was considered as statistically significant difference.Results There were no significant difference between two groups,in terms of the average operation time,blood loss,postoperative ventilation time,eating time,hospitalization time and ALB increase at 1 month after operation(P>0.05).There were 6 cases(16.7%)of gastric emptying disorder in the traditional group,while no gastric emptying disorder occurred in the modified group,with statistically significant difference(P=0.032).The total postoperative complication rate of 4.0%in the improved group was significantly lower than 22.2%in the traditional group,with statistically significant difference(P=0.048).The postoperative satisfaction of patients in improved group was signifcantly high than that in traditional group,with statistically significant difference(P=0.016).Conclusion Modified Devine operation could significantly relieve the symptoms and reduce the postoperative complications and improve satisfaction.It is a safe and effective surgical method,which is worthy of promotion and application.