近端胃切除术Cheng′s GIRAFFE?重建100例食管胃结合部腺癌患者功能性疗效分析

Functional outcomes of 100 patients with adenocarcinoma of the esophagogastric junction undergoing Cheng's GIRAFFE® reconstruction after proximal gastrectomy

目的探讨对食管胃结合部腺癌患者进行近端胃切除采用Cheng′s GIRAFFE®重建术(GIRAFFE重建)的功能性效果和术后并发症情况。方法采用描述性病例系列研究的方法。回顾性分析2017年9月至2021年6月,在中国科学院大学附属肿瘤医院(64例)、浙江省中医院(24例)、浙江丽水中心医院(10例)以及浙江湖州中心医院(1例)和宁波李惠利医院(1例)完成的近端胃切除+GIRAFFE重建并进行术后随访的共计100例食管胃结合部腺癌患者的资料。其中男性64例,女性36例;年龄(61.3±11.1)岁,体质指数(22.7±3.1)kg/m^(2);肿瘤TNM分期:ⅠA期68例,ⅡA期24例,ⅡB期8例。分析总结胃癌根治手术并GIRAFFE重建的术后功能性结果和术后并发症情况,通过术后随访时的胃食管反流疾病问卷(RDQ)及内镜检测,评估反流性食管炎发生及其Grade分级情况(反流情况由轻到重分为N、A、B、C和D级)。符合正态分布的计量资料以±s表示,不符合正态分布的计量数据以M(Q1,Q3)表示。结果全组100例患者均顺利完成肿瘤的R0切除,腹腔镜手术77例,开腹手术23例;GIRAFFE重建吻合时间(38.6±14.0)min,术中出血量(73.0±18.4)ml。术后住院时间9.5(8.2,13.0)d,住院费用(6.0±0.3)万元。围手术期14例(14.0%)出现并发症,其中胸腔积液或肺炎7例,吻合口漏3例,胃排空障碍2例,消化道出血和吻合口狭窄各1例,均予以对症处理好转移后出院。全组患者术后随访(33.3±1.6)个月,RDQ量表发现8例(8.0%)存在反流症状;胃镜检查发现反流性食管炎11例(11.0%),其中6例为A级,3例为B级,2例为C级。所有患者通过行为指导或口服质子泵抑制剂(PPI)类药物均可控制反流症状。结论采用GIRAFFE吻合重建消化道术后,抗反流效果和胃排空功能较好,可成为近端胃切除术后重建方式选择之一。

Objective To investigate the functional outcomes and postoperative complications of Cheng's GIRAFFE reconstruction after proximal gastrectomy.Methods A descriptive case series study was conducted.Clinical data of 100 patients with adenocarcinoma of the esophagogastric junction who underwent Cheng's GIRAFFE reconstruction after proximal gastrectomy in Cancer Hospital of University of Chinese Academy of Sciences(64 cases),Zhejiang Provincial Hospital of Chinese Medicine(24 cases),Lishui Central Hospital(10 cases),Huzhou Central Hospital(1 case)and Ningbo Lihuili Hospital(1 case)from September 2017 to June 2021 were retrospectively analyzed.Of 100 patients,64 were males and 36 were females;the mean age was(61.3±11.1)years and the BMI was(22.7±11.1)kg/m^(2).For TNM stage,68 patients were stage IA,24 were stage IIA and 8 were stage IIB.Postoperative functional results and postoperative complications of radical gastrectomy with Giraffe reconstruction were analyzed and summarized.Gastroesophageal reflux disease questionnaire(RDQ)score and postoperative endoscopy were used to evaluate the occurrence of reflux esophagitis and its grade(grade N,grade A,grade B,grade C,and grade D from mild to severe reflux).The continuous data conforming to normal distribution were expressed as(mean±standard deviation),and those with skewed distribution were presented as median(Q1,Q3).Results All the 100 patients successfully completed R0 resection,including 77 patients undergoing laparoscopic surgery and 23 patients undergoing laparotomy.The Giraffe anastomosis time was(38.6±14.0)min;the blood loss was(73.0±18.4)ml;the postoperative hospital stay was 9.5(8.2,13.0)d;the hospitalization cost was(6.0±0.3)ten thousand yuan.Fourteen cases developed perioperative complications(14.0%),including 7 cases of pleural effusion or pneumonia,3 cases of anastomotic leakage,2 cases of gastric emptying disorder,1 case of gastrointestinal hemorrhage and 1 case of anastomotic stenosis,who were all improved and discharged after symptomatic management.Patients were followed up for(33.3±1.6)months.Eight patients were found to have reflux symptoms by RDQ scale six months after surgery,and 11 patients(11/100,11.0%)were found to have reflux esophagitis by gastroscopy,including 6 in grade A,3 in grade B,and 2 in grade C.All the patients could control their reflux symptoms with behavioral guidance or oral PPIs.Conclusion Cheng's GIRAFFE reconstruction has good anti-reflux efficacy and gastric emptying function;it can be one of the choices of reconstruction methods after proximal gastrectomy.