腹腔镜下近端胃癌根治术中食管胃前壁吻合对术后胃食管反流和营养状况的影响

Effect of front esophagus wall anastomosis after loparoscopic radical gastrectomy on postoperative gastroesophageal reflux and nutritional status

目的探讨腹腔镜下近端胃癌根治术中食管胃前壁吻合在改善术后胃食管反流和营养状况方面的作用。方法选取2020年4月至2022年4月在郑州大学附属肿瘤医院就诊的78例近端胃癌患者为研究对象,按照随机数字表法分为对照组与研究组,每组39例。所有患者均行腹腔镜下近端胃癌根治术,对照组患者给予传统吻合术,研究组患者给予腹腔镜下食管胃前壁吻合术。观察并记录两组患者手术用时、术中出血量、胃肠蠕动恢复时间、胃液引流量和住院时间。采用DeMeester法评价术后胃食管反流情况,采用胃镜观察吻合口狭窄情况。分别于术前、术后3个月、术后6个月和术后12个月,检测两组患者血红蛋白(Hb)、总蛋白(TP)、白蛋白(Alb)水平。结果两组患者手术用时和术中出血量比较,差异未见统计学意义(P>0.05)。研究组胃肠蠕动恢复时间、胃液引流量和住院时间均明显小于对照组(P<0.05)。研究组患者胃食管反流和吻合口狭窄发生率均明显低于对照组(P<0.05)。两组患者Hb水平交互差异未见统计学意义(FHb_(交互)=0.242,PHb_(交互)=0.867),组间(FHb_(组间)=3.520,PHb_(组间)<0.001)和时间(FHb_(时间)=11.592,PHb_(时间)<0.001)差异有统计学意义;Alb(FAlb_(交互)=11.562,PAlb_(交互)<0.001;FAlb_(组间)=99.448,PAlb_(组间)<0.001;FAlb_(时间)=212.63,PAlb_(时间)<0.001)、TP(FTP_(交互)=10.374,PTP_(交互)<0.001;FTP_(组间)=121.643,PTP_(组间)<0.001;FTP_(时间)=54.838,PTP_(时间)<0.001)水平组间、时间和交互差异均有统计学意义。结论腹腔镜下近端胃癌根治术中食管胃前壁吻合有利于术后患者消化道重建,降低胃食管反流发生率,改善患者营养状况。

Objective To investigate the effects of front esophagus wall anastomosis after laparoscopic radicalgl astrectomyy on postoperative gastroesophageal reflux and nutritional status.Methods A total of 78 patients with gastric cancer treated in Henan Cancer Hospital were enrolled from April 2020 to April 2022.According to random number table method,they were divided into control group and study group,with 39 cases in each group.All patients unduent laparoscopic radical gastrectomy,and the control group was treated with traditional anastomosis,while the study group was treated with laparoscopic front esophagus wall anastomosis.The operation time,intraoperative blood loss,recovery time of gastrointestinal peristalsis,drainage volume of gastric fluid and hospitalization time were observed and recorded.The postoperative gastroesophageal reflux was evaluated by DeMeester method,and anastomotic stenosis was observed by gastroscopy.Before surgery,at 3 months,6 months and 12 months after surgery,the levels of hemoglobin(Hb),total protein(TP)and albumin(Alb)were detected.Resultss There was no significant dfference in operation time or intraoperative blood loss between the two groups(P>0.05).The recovery time of gastrointestinal peristalsis,drainage volume of gastric fluid and hospitalization time in the study group were significantly lower than those in the control group(P<0.05).The incidences of gastroesophageal reflux and anastomotic stenosis in the study group were significantly lower than those in the control group(P<0.05).There was no significant difference in Hb level between the two groups in interaction dimension(FHb interaction=0.242,PHb interaction=0.867),but there were significant differences in between-group dimension(FHb between-group=3.520,PHb between-group<0.001)and time dimension(FHb time=11.592,PHb time<0.001).There were significant differences in Alb level(FAlb interaction=11.562,PAlb interaction<0.001;FAlb between-group=99.448,PAlb between-group<0.001;FAlb time=212.63,PAlb time<0.001)and TP level(FTp interaction=10.374,PTp interaction<0.001;FTp between-group=121.643,PTp between-group<0.001;FTp time=54.838,PTp time<0.001)between the two groups in interaction dimension,between-group dimension and time dimension.Conclusions Front esophagus wall anastomosis after loparoscopic radical gastrectomy is beneficial to reconstruct digestive tract,reduce the incidence of gastroesophageal reflux and improve the nutritional status of patients.