腹腔镜近端胃癌根治术中双通路胃间置术与双通路空肠间置术治疗效果比较

Comparison of double-tract gastric interposition and double-tract jejunal interposition after laparoscopic radical gastrectomy for proximal gastric cancer

目的比较腹腔镜近端胃癌根治术中消化道重建采用双通路胃间置术与双通路空肠间置术的效果及安全性,为消化道重建方式的选择提供依据。方法2021年1月—2022年1月南阳市第二人民医院行腹腔镜近端胃癌根治术患者70例,消化道重建方式采用双通路胃间置术者31例为观察组,采用双通路空肠间置术者39例为对照组,比较2组手术及术后恢复情况,术前及术后1、3、7 d血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、皮质醇、促肾上腺皮质激素(ACTH)水平,术前及术后1、3、12个月胃动素、胃泌素、总蛋白、血红蛋白水平及体质量、生活质量评分,术后并发症发生率。结果观察组肠鸣音恢复时间[(26.13±5.08)h]、首次排气时间[(34.51±8.16)h]、住院时间[(8.64±2.17)d]均短于对照组[(30.28±6.71)h、(40.29±10.35)h、(10.61±2.39)d](P<0.05),手术时间、淋巴结清扫数目、术中出血量与对照组比较差异均无统计学意义(P>0.05)。观察组术后1、3、7 d血清CRP[(31.71±8.64)、(20.13±5.39)、(16.42±4.15)mg/L]、IL-6[(26.54±5.17)、(20.49±4.52)、(12.38±2.81)ng/L]、皮质醇[(402.51±30.48)、(352.79±26.83)、(281.94±26.58)nmol/L]、ACTH[(34.26±5.18)、(30.18±3.69)、(28.62±2.90)ng/L]水平均低于对照组[CRP:(40.26±9.78)、(26.07±5.81)、(20.36±4.31)mg/L;IL-6:(31.62±6.05)、(25.17±5.36)、(15.13±3.30)ng/L;皮质醇:(441.26±35.17)、(390.62±30.15)、(312.26±28.77)nmol/L;ACTH:(40.25±6.03)、(34.21±4.35)、(31.05±3.16)ng/L](P<0.05),术前与对照组比较差异均无统计学意义(P>0.05);2组术后1、3、7 d血清CRP、IL-6、皮质醇、ACTH水平均高于术前(P<0.05),均依次降低(P<0.05)。观察组术后1、3、12个月血清胃动素、胃泌素、总蛋白、血红蛋白水平及体质量、生活质量评分均高于对照组(P<0.05),术前与对照组比较差异均无统计学意义(P>0.05);2组术前及术后1、3、12个月血清胃动素、胃泌素水平均依次降低(P<0.05),血清总蛋白、血红蛋白水平及体质量、生活质量评分均依次升高(P<0.05)。观察组食物残留发生率(6.45%)低于对照组(25.64%)(χ^(2)=4.480,P=0.034),反流性食管炎、烧心、腹泻、倾倒综合征发生率与对照组比较差异均无统计学意义(P>0.05)。结论腹腔镜近端胃癌根治术中消化道重建采用双通路胃间置术可减轻患者炎症应激反应,改善胃肠功能及营养状况,降低食物残留发生率,提高生活质量。

Objective To compare the effect and safety of double-tract gastric interposition versus double-tract jejunal interposition after laparoscopic radical resection of proximal gastric cancer,and to provide a theoretical basis for digestive reconstruction.Methods Seventy patients underwent laparoscopic radical gastrectomy for proximal gastric cancer in Nanyang Second People's Hospital from January 2021 to January 2022,among whom 31 patients received double-tract gastric interposition(observation group)and 39 patients received double-tract jejunal interposition(control group).The operation process,postoperative recovery,levels of serum inflammatory stress factors[C-reactive protein(CRP),interleukin-6(IL-6),cortisol,adrenocorticotropin(ACTH)]before operation and 1,3 and 7 d after operation,serum gastrointestinal hormone levels(motilin,gastrin),hemoglobin,total protein,body mass and quality of life(QOL)score before operation and 1,3 and 12 months after operation,and incidence of postoperative complications were compared between two groups.Results The recovery time of bowel sounds,time to first exhaust and length of hospital stay were shorter in observation group[(26.13±5.08)h,(34.51±8.16)h,(8.64±2.17)d]than those in control group[(30.28±6.71)h,(40.29±10.35)h,(10.61±)d](P<0.05),and there were no significant differences in operation lasting time,number of lymph node dissection and intraoperative blood loss between two groups(P>0.05).The levels of serum CRP[(31.71±8.64),(20.13±5.39),(16.42±4.15)mg/L],IL-6[(26.54±5.17),(20.49±4.52),(12.38±2.81)ng/L],cortisol[(402.51±30.48),(352.79±26.83),(281.94±26.58)nmol/L]and ACTH[(34.26±5.18),(30.18±3.69),(28.62±2.90)ng/L]by day 1,3 and 7 after operation in observation group were significantly lower than those in control group[CRP:(40.26±9.78),(26.07±5.81),(20.36±4.31)mg/L;IL-6:(31.62±6.05),(25.17±5.36),(15.13±3.30)ng/L;cortisol:(441.26±35.17),(390.62±30.15),(312.26±28.77)nmol/L;ACTH:(40.25±6.03),(34.21±4.35),(31.05±3.16)ng/L](P<0.05),and all above indexes showed no vsignificant differences before operation between two groups(P>0.05).The levels of CRP,IL-6,cortisol and ACTH by day 1,3 and 7 after operation were higher than those before operation in both groups(P<0.05),and decreased sequentially(P<0.05).The levels of serum motilin,gastrin,total protein,hemoglobin,body mass and QOL score were higher in observation group than those in control group in 1.3 and 12 months after operation(P<0.05),and showed no significant differences before operation between two groups(P>0.05).The levels of serum motilin and gastrin decreased sequentially before operation and 1,3 and 12 months after operation in two groups(P<0.05),while the levels of serum total protein,hemoglobin,body mass and QOL score increased sequentially(P<0.05).The incidence of food residue was lower in observation group(6.45%)than that in control group(25.64%)(χ~2=4.480,P=0.034),and there were no significant differences in the incidences of reflux esophagitis,heartburn,diarrhea and dumping syndrome between two groups(P>0.05).Conclusion After laparoscopic radical gastrectomy for proximal gastric cancer,double-tract gastric interposition can reduce inflammatory stress response,improve gastrointestinal function and nutrient absorption,reduce the incidence of food residue,and improve the QOL.