中国实用外科杂志2024，Vol.44Issue(10)：1144-1148,1154,6.DOI:10.19538/j.cjps.issn1005-2208.2024.10.13
近端胃切除术不同消化道重建方式临床疗效比较:一项多中心真实世界研究
Comparison of the efficacy of different digestive tract reconstruction methods after proximal gastrectomy for gastric cancer:a multicenter real-world study
摘要
Abstract
Objective To compare the postoperative quality of life and efficacy of different digestive tract reconstruction methods after proximal gastrectomy.Methods A retrospective analysis was conducted on the clinicopathological data of 290 patients who underwent radical proximal gastrectomy at four centers from January 2018 to December 2023.Based on the reconstruction methods,the patients were divided into the following groups:83 cases in the Gastroesophageal End-to-Side Anastomosis group,74 cases in the Pouch Anastomosis group,54 cases in the Double Tract Anastomosis group,56 cases in the SOFY Anastomosis group,and 23 cases in the Kamikawa Anastomosis group.The observation indicators,including perioperative indicators,endoscopic reflux grading,nutritional status indicators,follow-up,and survival conditions,were compared between different groups.The follow-up period extends until April 2024.Results There were no statistically significant differences among the groups in terms of the number of lymph node metastases,reoperation rate,incidence of Grade Ⅲ and above complications,and perioperative mortality rate(P＞0.05).The End-to-Side group and SOFY group had significantly higher intraoperative blood loss compared to the other groups(P＜0.05).The Pouch group had significantly longer postoperative nasogastric tube retention days and hospital stays compared to the other groups(P＜0.05).The Kamikawa group showed a significant increase in the number of lymph nodes dissected and a lower incidence of postoperative complications compared to the other groups(P＜0.05).The End-to-Side group and Pouch group had higher postoperative mortality and recurrence rates compared to the other groups(P＜0.05).The incidence of Grade B or higher reflux esophagitis was 31.1％.The SOFY group and Kamikawa group showed significantly less postoperative reflux progression compared to the other groups(P＜0.05).One year after surgery,the Pouch group,SOFY group,and Kamikawa group completed PGSAS-45.There was no statistically significant difference in SF-8 quality of life,survival status,and quality of life among the three groups(P＞0.05).In terms of gastrointestinal symptoms,the Kamikawa group was significantly better than the gastric tube group and SOFY group(P＜0.05).Conclusion Among the different digestive tract reconstruction methods after proximal gastrectomy,SOFY anastomosis,and Kamikawa anastomosis have similar efficacy and are safe and feasible.They also offer greater advantages in postoperative anti-reflux compared to other anti-reflux techniques.关键词
胃癌/近端胃切除术/消化道重建/反流性食管炎/双肌瓣吻合/食管残胃侧壁吻合/生活质量Key words
gastric cancer/proximal gastrectomy/digestive tract reconstruction/reflux esophagitis/double flap anastomosis/side overlap with fundoplication/quality of life分类
医药卫生引用本文复制引用
黄勇,刘娟,张海翘,刘小野,王鹏,邵欣欣,谢天宇,唐云,田艳涛,张军,蔡军,郑智,苏向前,张忠涛,邢加迪,钟宇新,王鑫鑫,尹杰,徐凯,王子健,杜永星,周传永,黄子杰,卢一鸣,张政..近端胃切除术不同消化道重建方式临床疗效比较:一项多中心真实世界研究[J].中国实用外科杂志,2024,44(10):1144-1148,1154,6.基金项目
国家自然科学基金项目(No.82300646) （No.82300646）
北京市自然科学基金项目(No.7232334) （No.7232334）
北京市属医院科研培育项目(No.PX20240103,No.PX2020001) （No.PX20240103,No.PX2020001）
首都卫生发展科研专项项目(No.2024-2-2028) （No.2024-2-2028）
北京大学肿瘤医院临床研究青年基金项目(No.QNJJ2022019) （No.QNJJ2022019）
北京市科委AI+健康协同创新培育项目(Z241100007724004) （Z241100007724004）
