腹腔镜近端胃切除后Kamikawa吻合术与双通道吻合术的近期疗效的倾向性评分匹配分析

Propensity score matching analysis of the short-term efficacy of Kamikawa versus doubletract reconstruction in laparoscopic proximal gastric cancer surgery

目的比较Kamikawa吻合术与双通道吻合(DTR)术在近端胃切除术后的近期疗效。方法本研究采用倾向性评分匹配研究方法和回顾性队列研究方法。病例纳入标准为年龄20~70岁;经术前内镜活检病理诊断为胃癌;肿瘤直径≤4 cm且位于胃上1/3(包括食管胃交界处);TNM分期为ⅠA、ⅠB或ⅡA期。回顾性收集2020年6月至2023年2月期间在空军军医大学唐都医院胃肠外科行腹腔镜近端胃癌根治术的73例患者临床资料,其中行Kamikawa吻合术19例(Kamikawa组),行DTR术54例(DTR组)。使用R语言进行1∶2倾向性评分匹配患者的一般资料,最终Kamikawa组纳入17例,DTR组纳入34例。比较两组患者的手术相关情况、术后生活质量以及术后并发症等。结果倾向匹配后,两组基线资料差异无统计学意义(均P>0.05)。与DTR组相比较,Kamikawa组手术时间更长[(321.5±15.7)min比(296.8±26.1)min,t=32.056,P<0.001]、吻合时间更长[(93.0±6.8)min比(45.3±7.7)min,t=56.303,P<0.001],而出血量较少[76(54~103)ml比112(82~148)ml,Z=71.536,P<0.001],差异均有统计学意义。两组肿瘤大小、术后首次通气时间、术后住院时间、淋巴结清扫数量和清扫时间以及住院总费用的差异均未见统计学意义(均P>0.05)。中位随访时间(6.1±1.8)个月。在术后生活质量评价中,Kamikawa组较DTR组上消化道造影反流比率较低[0比29.4%(10/34),χ^(2)=6.220,P=0.013],差异有统计学意义;而两组在生活质量评分、随访3个月和6个月胃食管反流病(GERD)量表等方面差异均无统计学意义(均P>0.05)。Kamikawa组的术后并发症发生率为2/17,明显低于DTR组的41.2%(14/34),差异有统计学意义(χ^(2)=4.554,P=0.033)。结论Kamikawa吻合和DTR均为理想的近端胃术后消化道重建方式。虽然Kamikawa吻合耗时略长,对手术团队要求更高,但术后抗反流效果可能更佳。

Objective To compare the short-term efficacy of Kamikawa anastomosis and double-tract reconstruction(DTR)after proximal gastrectomy.Methods This was a propensity score matched,retrospective,cohort study.Inclusion criteria comprised age 20-70 years,diagnosis of gastric cancer by pathological examination of preoperative endoscopic biopsies,tumor diameter≤4 cm,and location in the upper 1/3 of the stomach(including the gastroesophageal junction),and TNM stage IA,IB,or IIA.The study cohort comprised 73 patients who had undergone laparoscopic proximal gastric cancer radical surgery in the Department of Gastroenterology,Tangdu Hospital,Air Force Medical University between June 2020 and February 2023,19 of whom were in the Kamikawa group and 54 in the DTR group.After using R language to match the baseline characteristics of patients in a ratio of 1:2,there were 17 patients in the Kamikawa group and 34 in the DTR group.Surgery-related conditions,postoperative quality of life,and postoperative complications were compared between the two groups.Results After propensity score matching,there were no statistically significant differences in baseline data between the two groups(P>0.05).Compared with the DTR group,the Kamikawa group had longer operative times(321.5±15.7 minutes vs.296.8±26.1 minutes,t=32.056,P<0.001),longer anastomosis times(93.0±6.8 minutes vs.45.3±7.7 minutes,t=56.303,P<0.001),and less bleeding(76[54~103]mL vs.112[82~148]mL,Z=71.536,P<0.001);these differences are statistically significant.There were no statistically significant differences between the two groups in tumor size,time to first postoperative passage of gas,postoperative hospital stay,number of lymph nodes removed,duration of lymph node dissection,or total hospitalization cost(all P>0.05).The median follow-up time was 6.1±1.8 months.As to postoperative quality of life,the Kamikawa group had a lower rate of upper gastrointestinal contrast reflux than did the DTR group(0 vs.29.4%[10/34],χ^(2)=6.220,P=0.013);this difference is statistically significant.However,differences between the two groups in quality of life score on follow-up of 3 months and 6 months on the Gastroesophageal Reflux Disease(GERD)scale were not statistically significant(all P>0.05).The incidence of postoperative complications was 2/17 in the Kamikawa group,which is significantly lower than the 41.2%(14/34)in the DTR group(χ^(2)=4.554,P=0.033).Conclusion Kamikawa anastomosis and DTR are equally safe and effective procedures for reconstructing the digestive tract after proximal gastric surgery.Although Kamikawa anastomosis takes slightly longer and places higher demands on the surgical team,it is more effective at preventing postoperative reflux.