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中华普外科手术学杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 526 -529. doi: 10.3877/cma.j.issn.1674-3946.2023.05.015

论著

腹腔镜近端胃切除术中背驮式间置空肠单通道重建术在AEG手术的安全性及抗反流效果研究
王鸿彬, 何晓(), 吴菁宙   
  1. 214400 江苏江阴,江阴市中医院急诊科
  • 收稿日期:2023-05-30 出版日期:2023-10-26
  • 通信作者: 何晓

Safety and anti-reflux effect of piggyback interposition single channel jejunal reconstruction in laparoscopic proximal gastrectomy for AEG

Hongbin Wang, Xiao He(), Jingzhou Wu   

  1. Department of Emergency, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin Jiangsu Province 214400, China
  • Received:2023-05-30 Published:2023-10-26
  • Corresponding author: Xiao He
  • Supported by:
    2022 Annual Scientific Research Project of Wuxi Municipal Health Commission(M202249)
引用本文:

王鸿彬, 何晓, 吴菁宙. 腹腔镜近端胃切除术中背驮式间置空肠单通道重建术在AEG手术的安全性及抗反流效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(05): 526-529.

Hongbin Wang, Xiao He, Jingzhou Wu. Safety and anti-reflux effect of piggyback interposition single channel jejunal reconstruction in laparoscopic proximal gastrectomy for AEG[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(05): 526-529.

目的

研究腹腔镜近端胃切除术(LPG)中背驮式间置空肠单通道重建术在食管胃结合部腺癌(AEG)手术的安全性及抗反流效果。

方法

回顾性分析2020年1月至2022年12月接受LPG治疗的56例AEG患者的临床资料,根据消化道重建方式不同分为双通道组(n=32)和单通道组(n=24)。两组均行LPG,双通道组采用背驮式间置空肠双通道重建术,单通道组采用背驮式间置空肠单通道重建术。数据统计处理由SPSS 22.0统计软件完成,围手术期相关指标、术后营养状况等计量资料采用(

x¯
±s)表示,组间比较行独立样本t检验;术后并发症情况等计数资料采用[例(%)]表示,行秩和检验或χ2检验。P<0.05表示差异有统计学意义。

结果

两组患者手术时间、消化道重建时间、术中出血量、淋巴结清扫数目、首次排气时间、术后住院时间、术后近期并发症情况、术后反流症状分级、RE严重程度及Gerd Q 总分比较,差异均无统计学意义(P>0.05)。而单通道组患者术后反流症状及反流性食管炎的发生率均略低于双通道组(12.5%vs.18.8%,8.3%vs.12.5%),但差异无统计学意义(P>0.05)。两组患者术后3个月白蛋白(ALB)、血红蛋白(HB)、总蛋白(TP)、体重指数(BMI)等营养指标较术前均显著降低(P<0.05),且单通道组各营养指标均明显高于双通道组(P<0.05)。

结论

LPG中背驮式间置空肠单通道重建术在AEG手术中安全可行,不仅达到了与双通道重建术相同的疗效,而且有降低患者术后反流的趋势,并更有利于患者术后营养恢复,是一种较为理想的消化道重建术式,值得临床应用推广。

Objective

To investigate the safety and anti-reflux effects of piggyback interposition jejunal single channel reconstruction in esophagogastric junction adenocarcinoma(AEG)during laparoscopic proximal gastrectomy(LPG).

Methods

Clinical data of 56 patients with AEG who received LPG from January 2020 to December 2022 were retrospectively analyzed,and they were divided into two-channel group(n=32)and single-channel group(n=24)according to different ways of digestive tract reconstruction. The two groups were treated with LPG. The two-channel group was treated with piggyback interposition jejunum double-channel reconstruction,and the single-channel group was treated with piggyback interposition jejunum single-channel reconstruction. SPSS 22.0 was used to analyze the data. Perioperative indicators,postoperative nutritional status and other measurement data were expressed by(

x¯
±s). Independent t test was performed for comparison between groups. Statistical data such as postoperative complications were represented by cases (%)Rank sum test or χ2 test. P<0.05 indicated that the difference was statistically significant.

Results

There were no significant differences in operation time,digestive tract reconstruction time,intraoperative blood loss,number of lymph node dissection,first exhaust time,postoperative hospital stay,recent postoperative complications,postoperative disturbance symptom grade,severity of RE and total score of Gerd Q between the two groups(P>0.05). The incidence of postoperative reflux symptoms and reflux esophagitis in the single channel group was slightly lower than that in the double channel group(12.5%vs.18.8%,8.3%vs.12.5%),but the difference was not statistically significant(P>0.05). Nutritional indexes such as albumin(ALB),hemoglobin(HB),total protein(TP)and body mass index(BMI)were significantly decreased in both groups 3 months after surgery(P<0.05),and nutritional indexes in the single channel group were significantly higher than those in the double channel group(P<0.05).

Conclusion

Piggyback interposition jejunum single channel reconstruction in LPG is safe and feasible in AEG surgery. It not only achieves the same efficacy as double channel reconstruction,but also has the tendency to reduce postoperative reflux and is more beneficial to postoperative nutritional recovery of patients. It is a relatively ideal digestive tract reconstruction method and worthy of clinical application and promotion.

表1 56例行LPG的AEG患者不同消化道重建方式两组一般资料比较[(
x¯
±s),例]
表2 56例AEG行LPG不同消化道重建术式两组患者围手术期相关指标比较(
x¯
±s
表3 56例AEG行LPG不同消化道重建术式两组患者术后并发症情况比较[例(%)]
表4 56例AEG行LPG不同消化道重建术式两组患者术后抗反流效果比较[(
x¯
±s),例]
表5 56例AEG行LPG不同消化道重建术式两组患者术后营养状况指标比较(
x¯
±s
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