改良自牵引后离断食管空肠吻合联合腹腔镜胃癌D_(2)根治术治疗进展期胃癌的效果

Efficacy of Modified Self-pulling and Latter Transection Followed by Esophagojejunostomy Combined with Laparoscopic Total Gastrectomy with D_(2) Radical Resection on Advanced Gastric Cancer

目的探讨改良自牵引后离断(SPLT)食管空肠吻合联合D_(2)式腹腔镜胃癌根治术(LTG)治疗进展期胃癌(AGC)患者的效果。方法选取2020年1月至2021年10月新乡市中心医院收治的67例AGC患者。按随机数表法将患者分成对照组(33例)和观察组(34例)。对两组患者行D_(2)式LTG。对照组患者术中接受食管空肠Roux-en-Y吻合,观察组患者术中接受改良SPLT食管空肠吻合。比较两组围手术期指标、并发症发生率以及手术前后主观综合营养评估法(SGA)评分、视觉模拟量表(VAS)评分、血清D-乳酸、二胺氧化酶(DAO)水平。结果与对照组比较,观察组术中失血量较少,手术时长、首次排气时间、术后进食时间较短(P<0.05)。术后1、3个月,两组SGA评分均较术前降低,观察组SGA评分较对照组低(P<0.05)。术后3、7 d,两组VAS评分均较术前降低,观察组VAS评分较对照组低(P<0.05)。术后1、3 d,两组血清D-乳酸、DAO水平均较术前升高,观察组血清D-乳酸、DAO水平较对照组低(P<0.05)。观察组并发症总发生率较对照组低(P<0.05)。结论采用改良SPLT食管空肠吻合联合D_(2)式LTG治疗AGC患者,可有效优化围手术期指标,改善机体营养状态,且对机体肠黏膜屏障功能的影响小。

Objective To explore the effect of modified self-pulling and latter transection(SPLT)esophagojejunostomy combined with laparoscopic total gastrectomy(LTG)with D_(2) radical resection in the treatment of patients of advanced gastric cancer(AGC).Methods From January 2020 to October 2021,67 patients with AGC in Xinxiang Central Hospital were selected.They were divided into control group(34 cases)and observation group(34 cases)according to random number table method.Both groups of patients underwent LTG with D_(2).The patients in control group received Roux-en-Y anastomosis of the esophagus and jejunum during operation,while the patients in observation group received modified SPLT esophagojejunostomy during operation.Perioperative indicators,incidence of complications,and the scores of subjective global assessment(SGA),visual analogue scale(VAS),serum D-lactic acid and diamine oxidase(DAO)levels before and after operation were compared between the two groups.Results The intraoperative blood loss in observation group was less than that in control group,and the operation time,first exhaust time and postoperative eating time in observation group were shorter than those in control group(P<0.05).One and three months after operation,the SGA scores of the two groups were lower than those before operation,and the SGA score of observation group was lower than that of control group(P<0.05).On the 3rd and 7th day after operation,the VAS scores of the two groups were lower than those before operation,and that in observation group was lower than that in control group(P<0.05).On the 1st and 3rd day after operation,the levels of serum D-lactic acid and DAO in the two groups were higher than those before operation,while those in observation group were lower than those in control group(P<0.05).The total incidence of complications in observation group was lower than that in control group(P<0.05).Conclusion Modified SPLT esophagojejunostomy combined with D_(2) LTG in the treatment of AGC patients can effectively optimize the perioperative indicators,improve the nutritional status of the body,and has little impact on the intestinal mucosal barrier function of the body.