胃窦浆肌瓣转移幽门成形术在早期贲门癌腹腔镜辅助近端胃切除术中的应用研究

Application Study of Gastric Antrum Plasma Muscle Flap Transfer Pyloroplasty in Laparoscopic Assisted Proximal Gastrectomy for Early Cardiac Cancer

目的:探讨胃窦浆肌瓣转移幽门成形术在早期贲门癌腹腔镜辅助近端胃切除术(LAPG)的应用效果及安全性。方法:回顾性分析2014年1月-2021年4月在莆田市第一医院实施LAPG手术的55例早期贲门癌患者的临床资料,按照治疗方法的不同分为观察组(n=27)与对照组(n=28)。观察组术中行胃窦浆肌瓣转移幽门成形术,对照组术中行纵切横缝式幽门成形术。比较两组手术相关指标、营养相关指标及胃排空障碍、吻合口狭窄及反流性食管炎发生情况。结果:观察组的肠蠕动恢复时间、住院时间分别为(2.06±0.39)d、(9.98±1.22)d,均短于对照组的(3.58±0.70)d和(15.76±3.64)d,差异均有统计学意义(P<0.05)。观察组胃液引流量为(171.34±8.25)mL,少于对照组的(256.40±13.92)mL,差异有统计学意义(P<0.05)。术后1个月,两组血红蛋白、血浆白蛋白及体重均低于术前,差异均有统计学意义(P<0.05)。术后1个月,观察组血红蛋白、血浆白蛋白及体重分别为(114.35±4.70)g/L、(34.80±1.35)g/L和(51.60±3.54)kg,均高于对照组的(110.22±2.68)g/L、(29.14±1.75)g/L及(47.97±1.50)kg,差异均有统计学意义(P<0.05)。术后3个月,观察组的反流性食管炎、胃排空障碍及吻合口狭窄发生率分别为7.41%、3.70%和0,均低于对照组的35.71%、25.00%及28.57%,差异均有统计学意义(P<0.05)。结论:早期贲门癌患者LAPG术后行胃窦浆肌瓣转移幽门成形术能够有效促进术后恢复,降低反流性食管炎等术后并发症。

Objective: To discuss the application effect and safety of gastric antrum plasma muscle flap transfer pyloroplasty in laparoscopic assisted proximal gastrectomy(LAPG) for early cardiac cancer. Method: The clinical data of 55 patients with early cardiac cancer who underwent LAPG operation in the Putian City First Hospital from January 2014 to April 2021 were retrospective analyzed. The patients were divided into observation group(n=27)and control group(n=28) according to different treatment methods. The observation group received gastric antrum plasma muscle flap transfer pyloroplasty, while the control group received pyloroplasty with longitudinal incision and transverse suture. Operation related indexes, nutrition-related indexes, gastric emptying disorder, anastomotic stenosis and reflux esophagitis were compared between two groups. Result: The recovery time of peristalsis and hospital stay in the observation group were(2.06±0.39) d and(9.98±1.22) d, respectively, which were shorter than(3.58±0.70) d and(15.76±3.64) d in the control group, the differences were statistically significant(P<0.05).Gastric juice drainage in the observation group was(171.34±8.25) mL, which was lower than(256.40±13.92) mL in the control group, the difference was statistically significant(P<0.05). 1 month after operation, hemoglobin,plasma albumin and body weight in both groups were lower than those before operation, the differences were statistically significant(P<0.05). 1 month after operation, hemoglobin, plasma albumin and body weight in the observation group were(114.35±4.70) g/L,(34.80±1.35)g/L and(51.60±3.54) kg, respectively, which were higher than(110.22±2.68) g/L,(29.14±1.75) g/L and(47.97±1.50) kg in the control group, the differences were statistically significant(P<0.05). 3 months after surgery, the incidence ratios of reflux esophagitis, gastric emptying disorder and anastomotic stenosis in the observation group were 7.41%, 3.70% and 0, respectively, which were lower than 35.71%, 25.00% and 28.57% in the control group, the differences were statistically significant(P<0.05).Conclusion: The gastric antrum plasma muscle flap transfer pyloroplasty after LAPG for patients with early cardiac cancer can effectively promote postoperative recovery and reduce postoperative complications such as reflux esophagitis.