上海交通大学学报（医学版）2025，Vol.45Issue(7)：874-882,9.DOI:10.3969/j.issn.1674-8115.2025.07.009
机器人与腹腔镜辅助近端胃切除联合双肌瓣吻合治疗早期胃上部癌的近期效果对比
A comparative analysis of the short-term efficacy of robotic and laparoscopic proximal gastrectomy combined with double-flap anastomosis in the treatment of early upper gastric cancer
摘要
Abstract
Objective·To compare the safety and short-term outcomes of robot-assisted versus laparoscopic-assisted proximal gastrectomy combined with double-flap esophagogastrostomy in the treatment of early upper gastric cancer.Methods·A retrospective cohort study was conducted to analyze the clinical and pathological data of 31 early gastric cancer patients who underwent proximal gastrectomy combined with double-flap esophagogastrostomy for gastrointestinal reconstruction at the Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,from September 2023 to March 2024.Based on the surgical approach,patients were divided into the robot-assisted surgery group(robotic group,20 cases)and the laparoscope-assisted surgery group(laparoscopic group,11 cases).General clinical data,intraoperative conditions,and postoperative recovery between the two groups were compared.At the 6-month postoperative follow-up,upper gastrointestinal radiography and esophagogastroscopy were performed to assess anastomotic stricture and gastroesophageal reflux disease.Additionally,the gastric cancer-specific module of the European Organization for Research and Treatment of Cancer(EORTC),Quality of Life Questionnaire-Stomach 22(QLQ-STO22),was used to evaluate the patients' quality of life.Results·The general data of the two groups,including gender,age,preoperative comorbidities,American Society of Anesthesiologists(ASA)classification,Siewert classification,and pathological staging of tumors,showed no statistically significant differences(all P>0.05).All patients successfully underwent the procedure without conversion to open surgery.The time for gastroesophageal anastomosis was significantly shorter in the robotic group compared to the laparoscopic group[(31.09±8.23)min vs(43.73±8.83)min,P<0.001],while there were no statistically significant differences in other intraoperative and postoperative parameters,including operative time,intraoperative blood loss,number of lymph nodes removed,duration of gastric tube placement,time to start a liquid diet,length of postoperative hospital stay,and incidence of postoperative complications(all P>0.05).At the 6-month postoperative follow-up,30 patients completed the follow-up,with one patient lost to follow-up in the robotic group.Upper gastrointestinal radiography and esophagogastroscopy results showed that only one patient in the laparoscopic group developed an anastomotic stricture,while one patient in the robotic group developed grade A and one developed grade B gastroesophageal reflux disease(GERD).In addition,one patient in the laparoscopic group also developed grade B GERD.The incidences of GERD and anastomotic stricture showed no statistically significant differences between the two groups(both P>0.05).EORTC QLQ-STO22 results indicated that the robotic group had significantly lower scores in the dimensions of dysphagia,gastroesophageal reflux,and dietary restrictions,as well as in the total score,compared to the laparoscopic group(all P<0.05).Conclusion·Robot-assisted proximal gastrectomy combined with double-flap esophagogastrostomy is safe and feasible.It shortens anastomosis time and offers potential advantages in postoperative functional recovery and quality of life improvement.关键词
机器人手术/近端胃切除/双肌瓣吻合/胃上部肿瘤Key words
robotic surgery/proximal gastrectomy/double-flap anastomosis/upper gastric cancer分类
医药卫生引用本文复制引用
木尔扎特·艾麦提,朱纯超,夏翔,张子臻,张业骞,刘涛,白龙,张浩宇,倪博,关玉静,王书昌,顾佳毅..机器人与腹腔镜辅助近端胃切除联合双肌瓣吻合治疗早期胃上部癌的近期效果对比[J].上海交通大学学报（医学版）,2025,45(7):874-882,9.基金项目
国家自然科学基金(82173215,82103510,82473077,82473065) （82173215,82103510,82473077,82473065）
上海市"医苑新星"青年医学人才培养资助计划(2022-65) （2022-65）
上海市卫生健康委员会卫生行业临床研究专项(202140458) （202140458）
上海市自然科学基金(22ZR1438800,23ZR1439400) （22ZR1438800,23ZR1439400）
上海交通大学医学院附属仁济医院培育基金项目(RJTJ22-MS-025). National Natural Science Foundation of China(82173215,82103510,82473077,82473065) （RJTJ22-MS-025）
Shanghai"Medical Rising Stars"Youth Medical Talent Cultivation and Funding Program(2022-65) （2022-65）
Shanghai Health Commission Clinical Research Special Fund(202140458) （202140458）
Shanghai Natural Science Foundation(22ZR1438800,23ZR1439400) （22ZR1438800,23ZR1439400）
Incubation Fund of Renji Hospital,Shanghai Jiao Tong University School of Medicine(RJTJ22-MS-025). （RJTJ22-MS-025）
