腹腔镜近端胃切除双通道吻合术与全胃切除Roux-en-Y消化道重建术的临床疗效观察比较

Comparison of clinical efficacy between laparoscopic proximal gastrectomy with double channel anastomosis and total gastrectomy with Roux-en-Y reconstruction of digestive tract

目的腹腔镜近端胃切除双通道吻合术与全胃切除Roux-en-Y消化道重建术的临床疗效观察比较。方法选取2019年5月至2021年7月商丘市第三人民医院收治50例近端胃癌患者作为研究对象,根据方法的不同将其分成试验组(n=25,采取腹腔镜近端胃切除双通道吻合术)和常规组(n=25,采取全胃切除Roux-en-Y消化道重建术),对比两组患者手术前后血清前蛋白水平及体质量指数情况;对比两组患者围手术期临床指标、术后1年并发症、生存质量、Visick分级及术后3年生存率。结果手术前两组体质量、血清血红蛋白、白蛋白、总蛋白含量比较无统计学意义(P>0.05),术后1年试验组体质量、血清血红蛋白、白蛋白、总蛋白含量分别为(19.05±2.25)kg/m^(2)、(122.35±21.23)g/L、(336.52±36.09)g/L和(75.27±18.29)g/L,均高于常规组(P<0.05);试验组手术时间(199.20±30.52)min、术中出血量(91.87±29.56)mL、恢复正常饮食时间(28.67±8.95)d、术后肛门排气时间(3.60±1.76)d、首次进食时间(3.61±1.80)d、住院时间(9.67±2.83)d及清扫淋巴结数量(34.01±5.62)个,与常规组相关指标比较无统计学意义(P>0.05);试验组术后1年内并发症发生率12%,与常规组(32%)比较差异有统计学意义(P<0.05);试验组Visick分级均优于常规组(P<0.05);实验组生存质量评分为(89.76±17.21)分,高于常规组的(78.98±16.80)分(P<0.05),实验组术后3年生存率跟常规组比较无统计学意义(P>0.05)。结论对近端胃癌患者行腹腔镜近端胃切除双通道吻合术与全胃切除Roux-en-Y消化道重建术均能够达到较好手术效果,但腹腔镜近端胃切除双通道吻合术能更好地改善患者术后营养状态,提高生存质量,更适合近端胃癌手术患者。

Objective To observe and compare the clinical efficacy of laparoscopic proximal gastrectomy with double channel anastomosis and total gastrectomy with Roux-en-Y reconstruction of digestive tract.Methods A total of 50 patients with proximal gastric cancer admitted to our hospital from May 2019 to July 2021 were selected as the research subjects.According to different methods,they were divided into experimental group(n=25,laparoscopic proximal gas⁃trectomy with double channel anastomosis)and conventional group(n=25,total gastrectomy with Roux-en-Y diges⁃tive tract reconstruction).Serum preprotein levels and body mass index were compared between the two groups before and after surgery.Perioperative clinical indicators,postoperative complications 1 year,quality of life,Visick grade and postoperative 3-year survival rate were compared between the two groups.Results There was no statistical significance in body weight,serum hemoglobin,albumin and total protein contents between the two groups before operation(P>0.05).Body weight,serum hemoglobin,albumin and total protein contents of the experimental group were(19.05±2.25)kg/m^(2),(122.35±21.23)g/L,(336.52±36.0)g/L and(75.27±18.29)g/L one year after operation,were higher than those in conventional group(P<0.05);Operation time of the experimental group was(199.20±30.52)min,intraoperative blood loss was(91.87±29.56)mL,normal diet time was(28.67±8.95)d,postoperative anal exhaust time was(3.60±1.76)d,first feeding time was(3.61±1.80)d,and hospital stay was(9.67±2.83)d and the number of lymph nodes(34.01±5.62),there was no statistical significance compared with the conventional group(P>0.05).The incidence of complications in the experimental group was 12%within 1 year af⁃ter surgery,and the difference was statistically significant compared with the conventional group(32%)(P<0.05).The Visick grading of experimental groups was better than that of conventional group(P<0.05).The quality of life score of the experimental group was(89.76±17.21)points,which was higher than that of the conventional group(78.98±16.80)points(P<0.05),and the 3-year survival rate of the experimental group was not statistically signif⁃icant compared with the conventional group(P>0.05).Conclusion Laparoscopic double channel anastomosis and to⁃tal gastrectomy Roux-en-Y digestive tract reconstruction can achieve good surgical results for patients with proximal gastric cancer,but laparoscopic double channel anastomosis can better improve postoperative nutritional status and quali⁃ty of life,and is more suitable for patients with proximal gastric cancer surgery.