胃肠/肠肠“优势通道”在胃上部癌近端胃切除双通道吻合术后短期临床疗效分析

Short-term clinical efficacy of proximal gastrectomy with double tract reconstruction for locally advanced proximal gastric cancer

目的:比较胃上部癌行根治性近端胃切除联合双通道吻合术后胃肠优势通道或肠肠优势通道的近期临床效果。方法:回顾性分析2017年1月—2021年7月合肥市第二人民医院诊治的72例胃上部癌患者的临床资料,分别行根治性全胃切除+食管空肠Roux-en-Y吻合29例(全胃组),根治性近端胃癌切除+双通道吻合43例(近端胃组),在双通道吻合组根据X线造影结果分成胃肠优势通道组(26例)和肠肠优势通道组(17例)。结果:全胃组淋巴结清扫数目多于近端胃组[(27.9±3.2)枚比(25.4±2.9)枚, t=3.441, P=0.001]。近端胃切除组手术时间较全胃切除组长,术后12个月血清白蛋白[(36.1±2.4)g/L比(34.1±2.3)g/L, t=3.526, P=0.001]、血红蛋白[(122.9±6.9)g/L比(115.9±6.0)g/L, t=4.444, P=0.000]、维生素B12[(349.0±21.7)pmol/ml比(77.9±8.5)pmol/ml, t=63.931, P=0.000]水平均比全胃组高,BMI下降低于全胃组[(23.01±0.78)kg/m 2比(21.95±0.67)kg/m 2, t=5.978, P=0.000]。胃肠优势通道组与肠肠优势通道组术后12个月维生素B12水平、BMI下降、血清白蛋白、血红蛋白水平差异均无统计学意义(均 P>0.05)。 结论:对胃上部癌采用腹腔镜辅助近端胃癌根治切除联合术后双通道吻合安全可行,与全胃切除术相比均可有效改善术后营养状况,减少巨幼红细胞性贫血的发生。

Objective To compare the short-term clinical effect of gastrointestinal or enterointestinal dominant channels after radical proximal gastrectomy combined with dual-channel anastomosis for upper gastric cancer.Methods A total of 72 patients in Hefei Second People's Hospital from Jan 2017 to Jul 2021 were retrospectively analyzed,including 29 patients in the total gastrectomy group,and 43 patients in the group of radical proximal gastrectomy+dual-channel anastomosis,and by imaging results it was futher stratified into gastrointestinal dominant channel sub-group(26 cases)and intestinal dominant channel sub-group(17 cases).Results The number of lymph node dissection in the total gastrectomy group was more than that in the proximal stomach group(27.9±3.2 vs.25.4±2.9,t=3.441,P<0.05).While the 12 months post operation albumin[(36.1±2.4)g/L vs.(34.1±2.3)g/L,t=3.526,P=0.001],hemoglobin[(122.9±6.9)g/L vs.(115.9±6.0)g/L,t=4.444,P=0.000],vitamin B12[(349.0±21.7)pmol/ml vs.(77.9±8.5)pmol/ml,t=63.931,P=0.000]level,and the body mass index[(23.01±0.78)kg/m2vs.(21.95±0.67)kg/m2,t=5.978,P=0.000]decline level was unfavored(P<0.05).The 12 months post operation vitamin B12 level,body mass index,albumin and hemoglobin level had no statistical difference in the two subgroups of proximal gastrectomy(all P>0.05).Conclusions Laparoscopic proximal gastrectomy with double tract reconstruction for proximal gastric cancer is safe and reliable,which can effectively improve the postoperative nutritional status,prevent postoperative anemia.