Application of double tract reconstruction in laparoscopic assisted proximal gastrectomy for early upper gastric cancer
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摘要: 目的 探讨双通道空肠间置(DTR)在腹腔镜辅助近端胃切除术治疗早期胃上部癌中的应用价值。 方法 回顾性分析接受腹腔镜辅助近端胃切除术治疗的78例早期胃上部癌患者的临床资料,按照消化道重建方式分组,将43例接受传统食管残胃吻合(EG)术的患者纳入EG组,另35例接受DTR术的患者纳入DTR组。2组患者均由同组经验丰富的医师完成手术,术后门诊复查,均至少成功随访1年,且保留完整随访资料,比较2组围术期基本指标、术后并发症发生率、机体营养状况及每日进餐数情况等。 结果 DTR组术后通气时间显著短于EG组,手术时间显著长于EG组(P<0.05); 术后1年随访显示, DTR组反流性食管炎发生率为8.57%, 显著低于EG组的30.23%(P<0.05); DTR组术后6个月VisickⅠ~Ⅱ级者占比为85.71%, 显著高于EG组的65.12%(P<0.05); DTR组术后6个月、1年的血红蛋白(Hb)水平较出院时显著升高(P<0.05), 且显著高于同期EG组(P<0.05); DTR组患者术后1年时基本恢复正常进食,每日进餐3次、≥4次者分别占88.57%、11.43%, 进食恢复情况显著优于EG组(P<0.05)。 结论 在早期胃上部癌患者腹腔镜辅助近端胃切除术过程中选择DTR行消化道重建,能缩短患者术后通气时间,减少反流性食管炎发生,改善营养状况,促进正常进食习惯恢复。
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关键词:
- 胃上部癌 /
- 腹腔镜辅助近端胃切除术 /
- 双通道空肠间置术 /
- 消化道重建 /
- 近期疗效
Abstract: Objective To explore value of double tract reconstruction(DTR)in laparoscopic assisted proximal gastrectomy in the treatment of early upper gastric cancer. Methods The clinical data of 78 patients with early upper gastric cancer who received laparoscopic assisted proximal gastrectomy was analyzed retrospectively. According to different ways of digestive tract reconstruction, the patients were divided into two groups. A total of 43 patients who received traditional esophagogastrostomy(EG)were included in EG group, and 35 patients who received DTR were selected as DTR group. All patients were performed operations by experienced doctors in the same group, and completed the outpatient rechecks. Meanwhile, all of them were followed up successfully for at least one year, and the complete follow-up data were retained. The basic indexes of perioperative period, the incidence of postoperative complications, the nutritional status of the body and the conditions of daily meals were compared between the two groups. Results Compared with the EG group, the postopertive ventilation time in the DTR group was significantly shorter, and operation time was significantly longer(P<0.05). The result of one year follow-up showed that the incidence of reflux esophagitis in the DTR group was 8.57%, which was lower than 30.23% in the EG group(P<0.05). The proportion of patients with Ⅰ or Ⅱ Visick grading at 6 months after operation was 85.71%, which was significantly higher than 65.12% in the EG group(P<0.05); DTR group had significantly higher hemoglobin(Hb)- levels at 6 months and 1 year after operation compared with the time point of discharge(P<0.05), and they were significantly higher than that of EG group at the same time points(P<0.05). The patients in the DTR group all recovered to be normal diet after one year of operation, the proportions of patients having three meals and ≥ 4 meals per day accounted for 88.57% and 11.43%, respectively. The recovery condition of food-intake in the DTR group was significantly better than that of EG group(P<0.05). Conclusion DTR for digestive tract reconstruction can shorten postoperative ventilation time, reduce the occurrence of reflux esophagitis, improve the nutritional status and promote the recovery of normal eating habits in patients with upper gastric cancer during laparoscopic assisted proximal gastrectomy. -
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