腹腔镜辅助近端胃切除双通道吻合术与全胃切除Roux-en-Y消化道重建术治疗早期近端胃癌患者的效果比较

Compare effects of laparoscopic assisted proximal gastrectomy with double channel anastomosis and total gastrectomy with Roux-en-Y digestive tract reconstruction in treatment of patients with early proximal gastric cancer

目的:比较腹腔镜辅助近端胃切除双通道吻合术与全胃切除Roux-en-Y消化道重建术治疗早期近端胃癌患者的效果。方法:回顾性分析2018年1月至2021年12月该院收治的128例早期近端胃癌患者的临床资料,根据手术方式不同将其分为对照组和研究组各64例。对照组采用全胃切除Roux-en-Y消化道重建术治疗,研究组采用腹腔镜辅助近端胃切除双通道吻合术治疗,比较两组手术相关指标(手术时间、术中出血量、淋巴结清扫数量、术后肛门首次排气时间、肠鸣音恢复时间、首次进流食时间、首次下床活动时间、住院时间)、手术前后胃肠功能指标[胃动素(MTL)、血管活性肠肽(VIP)、生长抑素(SS)]、营养指标(白蛋白、血红蛋白)水平,以及手术前后体质量减少率和并发症发生率。结果:两组手术时间、术中出血量比较,差异均无统计学意义(P>0.05);研究组淋巴结清扫数量少于对照组,术后肛门首次排气时间、肠鸣音恢复时间、首次进流食时间、首次下床活动时间、住院时间均短于对照组,差异有统计学意义(P<0.05);术后,对照组血清MTL水平低于术前,VIP水平高于术前,两组血清SS水平均低于术前,但研究组血清MTL、SS水平均高于对照组,VIP水平低于对照组,差异有统计学意义(P<0.05);术后2、3个月及1年,研究组血清白蛋白、血红蛋白水平均高于对照组,差异有统计学意义(P<0.05);术后1、2、3个月,研究组体质量减少率均低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为9.38%(6/64),低于对照组的28.12%(18/64),差异有统计学意义(P<0.05)。结论:与全胃切除Roux-en-Y消化道重建术相比,腹腔镜辅助近端胃切除双通道吻合术治疗早期近端胃癌患者可加快胃肠功能恢复,缩短卧床和住院时间,改善营养状态,降低并发症发生率,但淋巴结清扫数量较少。

Objective:To compare effects of laparoscopic assisted proximal gastrectomy with double channel anastomosis and total gastrectomy with Roux-en-Y digestive tract reconstruction in treatment of patients with early proximal gastric cancer.Methods:The clinical data of 128 patients with early proximal gastric cancer admitted to the hospital from January 2018 to December 2021 were retrospectively analyzed.According to different surgical methods,they were divided into control group and study group,64 cases in each.The control group was treated with total gastrectomy with Roux-en-Y digestive tract reconstruction,while the study group was treated with laparoscopic assisted proximal gastrectomy with double channel anastomosis.The operation-related index levels(operation time,intraoperative blood loss,number of lymph node dissected,first anal exhaust time,bowel sound recovery time,first liquid diet time,first ambulation time,hospitalization time),the gastrointestinal function index levels[motilin(MTL),vasoactive intestinal peptide(VIP),somatostatin(SS)]before and after the surgery,the nutritional indexes(albumin,hemoglobin)levels,the weight loss rate,and the incidence of complications before and after the surgery were compared between the two groups.Results:There were no significant differences in the operation time and the intraoperative blood loss between the two groups(P>0.05).The number of lymph node dissected in the study group was less than that in the control group;the first anal exhaust time,the bowel sound recovery time,the first feeding time,the first ambulation time and the hospitalization time in the study group were shorter than those in the control group;and the differences were statistically significant(P<0.05).After the surgery,the serum MTL level in the control group was lower than that before the surgery,the VIP level was higher than that before the surgery,the serum SS level in the two groups was lower than that before the surgery,but the serum MTL and SS levels in the study group were higher than those in the control group,the VIP level was lower than that in the control group,and the differences were statistically significant(P<0.05).2,3 months and 1 year after the surgery,the levels of serum albumin and hemoglobin in the study group were higher than those in the control group,the differences were statistically significant(P<0.05).At 1,2 and 3 months after the surgery,the weight loss rate of the study group was lower than that of the control group,and the difference was statistically significant(P<0.05).Further,the incidence of complications in the study group was 9.38%(6/64),which was lower than 28.12%(18/64)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Compared to total gastrectomy with Roux-en-Y digestive tract reconstruction,laparoscopic assisted proximal gastrectomy with double channel anastomosis in the treatment of the patients with early proximal gastric cancer can accelerate the recovery of gastrointestinal function,shorten bed rest and hospital stay,improve nutritional status,and reduce the incidence of complications,but the number of lymph node dissected is less.