食管-胃前壁侧吻合与食管-胃后壁端侧吻合在腹腔镜近端胃癌根治术中的应用效果比较

Comparison on application effects of esophageal-gastric anterior wall side anastomosis and esophageal-gastric posterior wall end-side anastomosis in laparoscopic radical gastrectomy for proximal gastric cancer

目的 比较食-管胃前壁吻合与食管-胃后壁端侧吻合在腹腔镜近端胃癌根治术中的应用效果。方法 选择2020年10月至2022年10月南阳市第一人民医院收治的72例近端胃癌患者为研究对象,采用随机数字表法分为两组,每组36例。入组患者均行腹腔镜胃癌根治术,前壁组采用食管-胃前壁侧吻合,后壁组采用食管-胃后壁端侧吻合。比较两组围术期指标,统计两组术后6个月胃食管反流情况[胃食管反流病问卷(GerdQ)评分]及并发症,比较两组术前、术后6个月营养状况[血清总蛋白(TP)、白蛋白(ALB)、转铁蛋白(TRE)]。结果 两组围术期指标比较,差异未见统计学意义(P>0.05)。前壁组GerdQ量表总评分及各维度评分均低于后壁组,差异有统计学意义(P<0.05)。术后6个月,两组TP、ALB、TRE水平均高于术前,且前壁组TP、ALB、TRE水平高于后壁组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异未见统计学意义(P>0.05)。结论 在腹腔镜近端胃癌根治术中应用食管-胃前壁侧吻合能够减少术后胃食管反流症状,对于术后营养状况的改善具有积极作用。

Objective To compare the application effects of esophageal-gastric anterior wall side anastomosis and esophageal-gastric posterior wall end-side anastomosis in laparoscopic radical gastrectomy for gastric cancer.Methods A total of 72 patients with proximal gastric cancer admitted to the First People’s Hospital of Nanyang from October 2020 to October 2022 were selected as the study subjects,and were divided into two groups using the randomized numerical table method,with 36 cases in both groups.The enrolled patients underwent laparoscopic radical gastrectomy for gastric cancer,with esophagealgastric anterior wall side anastomosis in the anterior wall group and esophageal-gastric posterior wall endside anastomosis in the posterior wall group.The perioperative indexes were compared between the two groups,and gastroesophageal reflux[gastroesophageal reflux disease Questionnaire(GerdQ)scores]and complications were counted at 6 months after operation,and the nutritional status[serum total protein(TP),albumin(ALB),transferrin(TRE)]were compared between the two groups in the preoperative period and the 6-month postoperative period.Results There was no significant difference in the perioperative indicators between the two groups(P>0.05).The total score of GerdQ scale and the scores of each dimension of patients in the anterior wall group were lower than those in the posterior wall group(P<0.05).At 6 months after surgery,the levels of TP,ALB,and TRE were higher than those before surgery in both groups,and the levels of TP,ALB,and TRE were higher in the anterior wall group than those in the posterior wall group(P<0.05).There was no significant difference in the complications between the two groups(P>0.05).Conclusions Anterior esophagogastric anastomosis in laparoscopic radical gastrectomy for proximal gastric cancer is an effective method,which is able toreduce the symptoms of gastroesophageal reflux,and has a positive impact on the improvement ofpostoperative nutritional status.