改良食管胃吻合双肌瓣成形术与传统食管胃前壁吻合在腹腔镜近端胃癌根治术中的临床效果对比研究

Comparative study on the clinical effect of esophagogastric double muscle flap anastomosis and traditional esophagogastric anterior wall anastomosis during laparoscopic radical gastrectomy for proximalgastriccancer

目的:对比分析腹腔镜近端胃癌根治术(LPRG)中食管胃吻合双肌瓣成形术(Kamikawa 吻合)与传统食管胃前壁吻合的临床效果。方法:选取2020年1月至2022年4月接受LPRG治疗的80例胃肿瘤患者作为研究对象,采用随机数字表法将患者分为传统组和Kamikawa组,每组各40例。两组均行LPRG,传统组采用食管胃前壁吻合术,Kamikawa组采用Kamikawa 吻合术。数据应用软件SPSS 22.0处理,围手术期相关指标、营养状况指标等计量资料采用(xˉ±s)表示,组间比较行独立样本t检验,组内比较行配对t检验;术后并发症情况等计数资料行χ^(2)检验。P<0.05表示差异有统计学意义。结果:Kamikawa组手术时间及吻合时间均略长于传统组(P<0.05);两组患者术中出血量、淋巴结清扫数目、术后排气时间、术后进食流质时间及术后住院时间比较,差异无统计学意义(P>0.05)。Kamikawa组患者术后并发症的总发生率显著低于传统组(12.5% vs.32.5%),抗反流效果显著(P<0.05)。术后3个月两组患者血红蛋白(Hb)、白蛋白(ALB)、总蛋白(TP)、前白蛋白(PA)等营养指标较术前均显著降低(P<0.05),且Kamikawa组各营养指标均明显高于传统组(P<0.05)。结论:LPRG中Kamikawa吻合是安全可行的,虽延长了手术时间及吻合时间,但并未增加围手术期相关风险,并可有效降低患者术后并发症发生的风险,且抗反流效果显著,更有利于患者术后营养恢复,是一种较为理想的消化道重建术式,值得临床应用推广。

Objective To compare and analyze the clinical effects of laparoscopic radical gastrectomy(LPRG)for esophagogastric anastomosis(Kamikawa anastomosis)and traditional esophagogastric anterior wall anastomosis.Methods A total of 80 patients with gastric tumor who received LPRG treatment from January 2020 to April 2022 were selected as the research objects.The patients were divided into traditional group and Kamikawa group by random number table method,with 40 patients in each group.Both groups received LPRG,the traditional group received esophagogastric anterior wall anastomosis and the Kamikawa group received Kamikawa anastomosis.The data were processed by SPSS 22.O,and the measurement data of perioperative indicators and nutritional status indicators were expressed by(x+s).Independent t test was performed for inter-group comparison,and paired t test was performed for intra-group comparison.The statistical data of postoperative complications were X test.P<0.05 indicated statistically significant dfference.Results The operation time and anastomosis time of Kamikawa group were slightly longer than those of traditional group(P<0.05).There was no significant dfference in intraoperative blood loss,number of lymph node dissection,postoperative exhaust time, postoperative fluid intake time and postoperative hospital stay between the two groups(P>0. 05). The total incidence of postoperative complications in the Kamikawa group was significantly lowerthan that in the traditional group (12.5% vs. 32. 5%), and the anti-reflux effect was significant (P<0.05).Three months after surgery, the nutritional indexes of hemoglobin (Hb), albumin (ALB), total protein (TP)and prealbumin (PA) in 2 groups were significantly decreased compared with those before surgery (P<0. 05),and the nutritional indexes of Kamikawa group were significantly higher than those of traditional group (P<0. 05). Conclusion Kamikawa anastomosis in LPRG is safe and feasible. Although it prolongs the operationtime and anastomosis time, it does not increase perioperative related risks, and can effectively reduce the risk ofpostoperative complications in patients. Besides, the anti-reflux effect is significant, and it is more conducive topostoperative nutritional recovery of patients.