腹腔镜下早期近端胃癌根治术不同吻合方式的短期手术疗效观察

Short-term surgical effects of laparoscopic radical resection of early proximal gastric cancer with different anas⁃tomotic modes

目的探讨腹腔镜辅助近端胃切除双通道吻合术、程氏Giraffe重建术以及全胃切除Roux-en-Y消化道重建术用于早期近端胃癌的短期手术效果。方法收集早期近端胃癌患者临床资料,从中选取行腹腔镜辅助近端胃切除双通道吻合术、程氏Giraffe重建术以及全胃切除Roux-en-Y消化道重建术的患者各20例,比较三组患者的围术期和短期手术结果。结果三组患者均无中转开腹例数及术中并发症。三组手术时间、术中出血量、术后首次肛门排气时间、术后住院时间比较,差异均无统计学意义(F分别=2.24、1.72、0.97、1.29,P均>0.05)。Giraffe组住院费用明显高于双通道组和全胃切除组(LSD-t分别=1.37、1.70,P均<0.05)。三组患者在术前、术后1 d及术后4 d的C-反应蛋白水平、中性粒细胞计数、白细胞计数比较,差异均无统计学意义(F分别=0.77、1.92、0.49;1.43、3.17、1.33;2.21、2.39、0.29,P均>0.05)。三组患者术后3个月的血清白蛋白水平比较,差异有统计学意义(F=20.67,P<0.05),Giraffe组和双通道组血清白蛋白明显高于全胃切除组(LSD-t分别=4.63、3.69,P均<0.05),Giraffe组和双通道组比较,差异无统计学意义(LSD-t=1.19,P>0.05)。三组患者术后总并发症发生率比较,差异无统计学意义(χ^(2)=0.67,P>0.05)。结论腹腔镜辅助下近端胃切除双通道吻合术及程氏Giraffe重建术是安全可行的,近期疗效满意。与全胃切除组对比,近端胃切除双通道吻合术及程氏Giraffe重建术并不增加围术期并发症的总体发生率,而重建后的消化道更符合生理特点,术后患者营养状况更好。该三类手术均具有较好的抗反流作用。

Objective To investigate the short-term surgical effects of laparoscopic early proximal gastric cancer functional surgery with different anastomotic modes including laparoscopic assisted proximal gastrectomy with double tract reconstruction,Cheng Giraffe reconstruction,and total gastrectomy Roux-en-Y gastrointestinal reconstruction.Methods The clinical data of early proximal gastric cancer patients were collected.The patients who underwent laparoscopic assisted proximal gastrectomy double tract reconstruction,Cheng Giraffe reconstruction,and total gastrectomy Roux-en-Y gastrointestinal reconstruction were selected,with 20 cases in each.The perioperative and short-term surgical results of the three groups were compared.Results No cases of transant laparotomy and intraoperative complications was occurred in three groups.There was no significant difference in operation time,bleeding volume,first anal exhaust time,and hospitalization time among the three groups(F=2.24,1.72,0.97,1.29,P>0.05).The hospitalization cost of Giraffe group was significantly higher than that of the double tract group and the total gastrectomy group(LSD-t=1.37,1.70,P<0.05).There was no statistically significant difference in neutrophil count,Creactive protein levels,white blood cell count among three groups before surgery,1 day and 4 days after surgery(F=0.77,1.92,0.49,1.43,3.17,1.33,2.21,2.39,0.29,P>0.05).There was significant difference in serum albumin levels among three groups at 3 months after surgery(F=20.67,P<0.05),and the serum albumin in the Giraffe group and the double tract group was significantly higher than that in the total gastrectomy group(LSD-t=4.63,3.69,P<0.05).The difference in the serum albumin between Giraffe group and double tract group was not statistically significant(LSD-t=1.19,P>0.05).The incidence of total postoperative complications among three groups was not statistically significant(χ^(2)=0.67,P>0.05).Conclusion Laparoscopic proximal gastrectomy with double tract reconstruction and Cheng Giraffe reconstruction are safe and feasible,and the short-term curative effect is satisfactory.Compared with the total gastrectomy group,proximal gastrectomy double tract reconstruction and Cheng Giraffe reconstruction do not increase the overall incidence of perioperative complications,but the reconstructed digestive tract is more in line with physiological characteristics,and the nutritional status of the patients after operation was better.The three types of surgery have good anti-reflux effect.