腹腔镜胃节段切除术中保留迷走神经的临床研究

Clinical observation of vagus nerve preservation in laparoscopic segmental gastrectomy

目的探讨腹腔镜胃节段切除术中保留迷走神经对早期胃癌手术的临床疗效及术后质量的影响。方法前瞻性分析2016年1月至2020年1月60例不同术式治疗的早期胃癌患者资料,按照随机数表法分为SG组30例(行腹腔镜保留迷走神经的胃节段切除术)和DG组30例(行腹腔镜胃部分切除术)。采用SPSS 20.0统计软件处理数据,围术期相关指标、胃排空功能、胆囊收缩功能及生活质量评分采用(±s)表示,两组比较采用独立t检验;术后并发症发生情况采用χ^(2)检验。P<0.05为差异有统计学意义。随访评价两组患者术后肿瘤复发转移及生存情况。结果SG组手术时间显著长于DG组,肛门首次排气时间显著短于DG组(P<0.05);口服乙酰氨基酚后15、30、60 min SG组胃排空时间明显少于DG组(P<0.05),口服乙酰氨基酚后60 min SG组胆囊收缩功能优于DG组(P<0.05);SG组术后1年发生胃食管反流、倾倒综合征显著低于DG组,(P<0.05);两组术后生活质量评分逐渐上升,且SG组术后3、6、12个月的生活质量评分均高于DG组(P<0.05);随访期为12~60个月,SG组复发转移率6.7%(2/30)与DG组复发转移率10.0%(3/30)比较差异无统计学意义(P>0.05);两组患者随访期间均未出现死亡病例。结论对早期胃癌行胃节段切除术中保留迷走神经安全可行,可获得良好的临床疗效,患者术后胃功能恢复快,并显著改善患者的生活质量。

Objective To investigate the clinical outcome of preservation of the vagus nerve in laparoscopic segmental gastrectomy for early gastric cancer.Methods The clinical data of 60 patients with early gastric cancer treated with different surgical methods from January 2016 to January 2020 were analyzed prospectively.According to the random number table,they were divided into the laparoscopic segmental gastrectomy with vagus nerve preservation group(SG group,30 cases)and the laparoscopic partial gastrectomy group(DG group,30 cases).Statistical analysis were performed by using SPSS 20.0 software.Perioperative related indexes such as gastric emptying function,gallbladder systolic function and quality of life were expressed as and were examined by using independent t test.The incidence of postoperative complications were analyzed by usingχ^(2) test.A P value of<0.05 was considered as statistically significant difference.Follow-up were conducted to evaluate the postoperative tumor recurrence,metastasis and survival in both two groups.Results The operation time of SG group was significantly longer than that of DG group,and the first anal exhaust time was significantly shorter than that of DG group,with statistically significant difference(P<0.05).The gastric empty time of SG group was significantly shorter than those of DG group at 15,30 and 60min after oral acetaminophen respectively(P<0.05),and the gallbladder systolic function of SG group was better than those of DG group 60min after oral acetaminophen(P<0.05).The incidence of gastroesophageal reflux and dumping syndrome 1 year after operation in SG group was significantly lower than that in DG group,with statistically significant difference(P<0.05).The postoperative quality of life in both groups increased gradually,while the postoperative quality of life of the SG group was higher than those of the DG group at 3,6 and 12 months respectively(P<0.05).There was no statistical significance between two groups in terms of recurrence and metastasis rate of 6.7%(2/30)VS.10.0%(3/30)during the follow-up(P>0.05).There was no death in both groups during the follow-up.Conclusion It is safe and feasible to preserve the vagus nerve during segmental gastric resection for early gastric cancer,which could achieve good clinical outcome.The patient’s gastric function recovers quickly and the quality of life after surgery improves significantly.