Clinical effect of laparoscopic assisted double channel reconstruction of digestive tract in proximal gastrectomy

doi:10.3877/cma.j.issn.1674-3946.2022.03.009

Abstract

Abstract:

Objective

To investigate the clinical effect of laparoscopic assisted double channel reconstruction of digestive tract in proximal gastrectomy.

Methods

60 patients with upper gastric cancer treated from January 1，2018 to December 31，2020 were prospectively enrolled. They were randomly divided into group A，group B and group C by random number method，with 20 patients in each group. Patients in group A received laparoscopic assisted proximal gastrectomy and esophagogastrostomy，group B received laparoscopic assisted total gastric resection Roux-en-Y anastomosis，group C received laparoscopic assisted proximal stomach anastomosis of dual channel. SPSS 22.0 was used for statistical analysis. The measurement data of perioperative related indexes were expressed by（

x ˉ

±s）. One-way ANOVA was performed for comparison between multiple groups，LSD-t test was performed for comparison between two groups，paired sample t test was performed for intra-group comparison，and statistical data such as postoperative complications were performed by χ² test. P<0.05 indicated statistically significant difference.

Results

The operation time of group C was longer than that of group A and group B（P<0.05）；The incidence of postoperative reflux esophagitis in group C was significantly lower than that in group A and group B（P<0.05）. 6 months after operation，serum hemoglobin（Hb），total protein（TP），albumin（ALB）and prealbumin（PA）in the three groups were significantly lower than those before operation（P<0.05）. The nutritional indexes in group C were significantly higher than those in group A and group B（P<0.05）. SF-36 scores in group C were significantly higher than those in group A and group B at 6 months after surgery（P<0.05）.

Conclusion

Laparoscope-assisted dual-channel gastrointestinal reconstruction technique is safe and feasible in proximal gastrectomy，with significant anti-reflux effect，which is conducive to postoperative nutritional recovery and improvement of quality of life of patients.

Key words: Laparoscopes, Gastrectomy, Digestive tract reconstruction, Double channel, Comparative effectiveness research

Wulou Zhang, Lifeng Zheng, Hongda Liu. Clinical effect of laparoscopic assisted double channel reconstruction of digestive tract in proximal gastrectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(03): 263-266.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2022.03.009

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References 15

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组别	例	性别	年龄（岁）		BMI （kg/m²）		肿瘤直径（cm）
组别	例	男/女	年龄（岁）		BMI （kg/m²）		肿瘤直径（cm）
A组	20	12/8	61.4±5.3		22.1±2.3		2.6±0.9
B组	20	14/6	59.4±6.5		22.3±2.1		2.7±1.3
C组	20	13/7	60.1±6.1		21.6±2.5		2.4±1.2
χ²/F/Z		0.440	0.575		0.489		0.355
P		0.803	0.566		0.616		0.702
组别	例	肿瘤部位		TNM分期		分化程度
组别	例	A/B/C		Ⅰ/Ⅱ/Ⅲ		高/中/低
A组	20	11/7/2		11/6/3		12/6/2
B组	20	9/9/2		9/8/3		11/6/3
C组	20	10/7/3		10/6/4		10/8/2
χ²/F/Z		0.834		-0.275		-0.315
P		0.934		0.871		0.854

组别	例	性别	年龄（岁）		BMI （kg/m²）		肿瘤直径（cm）
组别	例	男/女	年龄（岁）		BMI （kg/m²）		肿瘤直径（cm）
A组	20	12/8	61.4±5.3		22.1±2.3		2.6±0.9
B组	20	14/6	59.4±6.5		22.3±2.1		2.7±1.3
C组	20	13/7	60.1±6.1		21.6±2.5		2.4±1.2
χ²/F/Z		0.440	0.575		0.489		0.355
P		0.803	0.566		0.616		0.702
组别	例	肿瘤部位		TNM分期		分化程度
组别	例	A/B/C		Ⅰ/Ⅱ/Ⅲ		高/中/低
A组	20	11/7/2		11/6/3		12/6/2
B组	20	9/9/2		9/8/3		11/6/3
C组	20	10/7/3		10/6/4		10/8/2
χ²/F/Z		0.834		-0.275		-0.315
P		0.934		0.871		0.854

组别	例	手术时间（min）	术中出血量（ml）	淋巴结清扫数目（枚）
A组	20	177.4±32.6	104.8±33.4	23.4±5.2
B组	20	192.8±36.3	110.3±35.2	25.1±5.1
C组	20	211.5±43.8^a	116.1±36.8	24.2±4.8
F		40.70	0.517	0.570
P		0.022	0.599	0.569
组别	例	首次排气时间（d）	首次进食时间（d）	术后住院时间（d）
A组	20	3.2±0.8	5.1±1.1	12.8±1.6
B组	20	3.3±1.0	5.0±1.2	13.1±1.4
C组	20	3.1±0.9	4.8±1.3	12.5±1.7
F		0.245	0.323	0.729
P		0.784	0.726	0.487

组别	例	手术时间（min）	术中出血量（ml）	淋巴结清扫数目（枚）
A组	20	177.4±32.6	104.8±33.4	23.4±5.2
B组	20	192.8±36.3	110.3±35.2	25.1±5.1
C组	20	211.5±43.8^a	116.1±36.8	24.2±4.8
F		40.70	0.517	0.570
P		0.022	0.599	0.569
组别	例	首次排气时间（d）	首次进食时间（d）	术后住院时间（d）
A组	20	3.2±0.8	5.1±1.1	12.8±1.6
B组	20	3.3±1.0	5.0±1.2	13.1±1.4
C组	20	3.1±0.9	4.8±1.3	12.5±1.7
F		0.245	0.323	0.729
P		0.784	0.726	0.487

组别	例	术后近期并发症
组别	例	吻合口漏		出血		感染	胃瘫		合计
A组	20	0		1		1	1		3
B组	20	1		0		1	1		3
C组	20	0		0		1	1		2
χ²		—		—		—	—		0.288
P		—		—		—	—		0.866
组别	例	术后远期并发症
组别	例	吻合口狭窄	肠梗阻		反流性食管炎			倾倒综合征
A组	20	2	2		9			1
B组	20	0	1		4			5
C组	20	1	0		2^a			1
χ²		2.105	2.105		8.012			5.089
P		0.349	0.349		0.018			0.079

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