分隔式与传统胃空肠吻合治疗晚期胃癌流出道梗阻的安全性及近期疗效比较研究

Safety and short-term efficacy of stomach-partitioning gastrojejunostomy versus conventional gastrojejunostomy for treating advanced gastric cancer with gastric outlet obstruction

目的比较分隔式胃空肠吻合术(SPGJ)与传统胃空肠吻合术(CGJ)治疗晚期胃癌伴胃流出道梗阻(GOO)的安全性及近期疗效。方法回顾性分析2015年3月至2022年3月首都医科大学附属北京友谊医院普外科收治的60例晚期胃癌伴GOO病人的临床资料,其中行SPGJ 40例(SPGJ组),行CGJ 20例(CGJ组),比较两组病人的手术和预后指标。结果SPGJ组与CGJ组病人在术后排气时间[3(1,1)d vs.5(3,6)d,P<0.001]、饮水时间[3(3,4)d vs.5(4,6)d,P<0.001]、进流食时间[5(4,5)d vs.6(6,7)d,P<0.001]、进半流食时间[7(6,7)d vs.8(7,11)d,P=0.001]、术后住院时间[7(6,8)d vs.9(8,13)d,P=0.001]、术后30 d恢复正常饮食比例(100%vs.85%,P=0.033)、术后胃排空延迟(DGE)发生率(2.5%vs.45%,P<0.001)、DGE分级(P<0.001)、总并发症发生率(5%vs.55%,P<0.001)及并发症分级(P<0.001)方面,差异具有统计学意义。结论对于晚期胃癌伴GOO病人,SPGJ在术后胃肠功能恢复、经口饮食恢复、住院时间、DGE发生率、DGE分级、总并发症发生率及并发症分级方面较CGJ具有显著优势。

Objective To explore the safety and short-term efficacy of stomach-partitioning gastrojejunostomy(SPGJ)versus conventional gastrojejunostomy(CGJ) for treating advanced gastric cancer with gastric outlet obstruction(GOO).Methods The clinical data of 60 patients with advanced gastric cancer with GOO admitted to Beijing Friendship Hospital Affiliated to Capital Medical University from March 2015 to March 2022 were retrospectively analyzed.Among them,40 patients underwent SPGJ(SPGJ group) and 20 underwent CGJ(CGJ group).Surgical outcomes,postoperative recovery outcomes,and prognostic outcomes of both groups were compared.Results In the SPGJ and CGJ groups,time to pass gas [3(1,1)d vs.5(3,6)d,P<0.001],time to oral intake [3(3,4)d vs.5(4,6)d,P<0.001],time to liquid intake [5(4,5)d vs.6(6,7)d,P<0.001],time to semi-liquid intake [7(6,7)d vs.8(7,11)d,P=0.001],postoperative hospital stay [7(6,8)d vs.9(8,13)d,P=0.001],return to normal diet 30 days after surgery(100% vs.85%,P=0.033),incidence of delayed gastric emptying(DGE)(2.5% vs.45%,P<0.001),DGE grade(P<0.001),total complications(5 % vs.55%,P<0.001) and complication grade(P<0.001),the differences were statistically significant.Conclusion For advanced gastric cancer with GOO,SPGJ has significant advantages over CGJ in postoperative gastrointestinal function recovery,oral diet recovery,hospital stay,DGE incidence,DGE grade,total complications,and complication grade.