两种消化道重建方案的腹腔镜近端胃切除术后患者胃内压变化的对比研究

A comparative study of gastric pressure after laparoscopic proximal gastrectomy for two kinds of digestive tract reconstruction

目的对比分析两种消化道重建方案的腹腔镜近端胃切除术(LPG)后患者的临床疗效及胃内压变化。方法选取2018年1月1日至2021年12月70例行LPG的胃癌患者作为研究对象,采用随机数字表法将患者分为两组,联合组和双通道组各35例。两组患者均行LPG,联合组采用自牵引后离断(SPLT)食管-空肠吻合与双重抗反流双通道残胃-空肠吻合重建(DADT)进行消化道重建,双通道组采用双通道吻合法进行消化道重建。数据应用软件SPSS 22.0处理,患者围手术期相关指标等计量资料采用(x^(-)±s)表示,两组间比较行独立样本t检验;术后并发症情况等计数资料采用[例(%)]表示,行χ^(2)检验。P<0.05表示差异有统计学意义。结果两组患者手术时间、消化道重建时间、术中出血量、术后肛门排气时间及术后住院时间比较,差异无统计学意义(P>0.05);而联合组淋巴结清扫数目显著多于双通道组,术后并发症总发生率显著低于双通道组(11.4%vs.31.4%),差异均有统计学意义(P<0.05)。时间与方法在胃内压及PH值水平上不存在交互作用(P>0.05),时间与方法在胃内压及PH值水平上主效应显著(P<0.05)。结论与双通道消化道重建方案相比,LPG中SPLT+DADT不仅提高了淋巴结清扫率,还可有效降低患者术后并发症的发生率,可进一步提高手术的安全性,且研究发现胃内压的变化与胃食管反流的发生密切相关。

Objective The clinical efficacy and changes of gastric pressure after laparoscopic proximal gastrectomy(LPG)for gastrointestinal reconstruction were compared and analyzed.Methods Seventy gastric cancer patients receiving LPG from January 1,2018 to December 2021 were selected as the research objects.The patients were divided into two groups by random number table method,35 cases in the combined group and 35 cases in the double-channel group.Patients in both groups were treated with LPG.The combined group was treated with esophagojejunal anastomosis after self-traction(SPLT)and dual anti-reflux dual-channel residual gastrojejunal anastomosis(DADT)for digestive tract reconstruction,and the double-channel group was treated with double-channel anastomosis for digestive tract reconstruction.The data were processed by SPSS 22.0 software,and measurement data such as perioperative indicators were represented by(x^(-)±s).Independent sample t test was performed for comparison between the two groups.Statistical data such as postoperative complications were represented by[cases(%)]andχ^(2) test was performed.P<0.05 indicated statistically significant difference.Results There were no significant differences in operation time,digestive tract reconstruction time,intraoperative blood loss,postoperative anal exhaust time and postoperative hospital stay between 2 groups(P>0.05).The number of lymph node dissection in the combined group was significantly higher than that in the two-channel group,and the total incidence of postoperative complications was significantly lower than that in the two-channel group(11.4%vs.31.4%),with statistical significance(P<0.05).There was no interaction between time and method on gastric pressure and PH level(P>0.05),but the main effect of time and method on gastric pressure and PH level was significant(P<0.05).Conclusion Compared with the dual-channel digestive tract reconstruction scheme,SPLT+DADT in LPG not only improves the lymph node clearance rate,but also effectively reduces the occurrence of postoperative complications and further improves the safety of surgery.Moreover,studies have found that changes in gastric pressure are closely related to the occurrence of gastroesophageal reflux.