PDF(Pubmed)
Abstract：
BACKGROUND: There is no consensus on the optimal reconstruction technique after proximal gastrectomy. The purpose of this study was to retrospectively compare the surgical outcomes among esophagogastrostomy (EG) anastomosis, gastric tube (GT) reconstruction and double-tract (DT) reconstruction in patients who underwent laparoscopic proximal gastrectomy (LPG) to clarify the superior reconstruction method.
METHODS: This study enrolled 164 patients who underwent LPG at the Northern Jiangsu People\'s Hospital in Jiangsu between January 2017 to January 2022 (EG: 51 patients; GT: 77 patients; DT: 36 patients). We compared the clinical and pathological characteristics, surgical features, postoperative complications, nutritional status, and quality of life (QOL) among the above three groups.
RESULTS: Mean operative time was longer with the DT group than the remaining two groups (p = 0.001). With regard to postoperative complications, considerable differences in the postoperative reflux symptoms (p = 0.042) and reflux esophagitis (p = 0.040) among the three groups were found. For the nutritional status, total protein, hemoglobin and albumin reduction rates in the GT group were significantly higher than the other two groups at 12 months postoperatively. In the PGSAS-45, three assessment items were better in the DT group significantly compared with the esophageal reflux subscale (p = 0.047, Cohen\'s d = 0.44), dissatisfaction at the meal (p = 0.009, Cohen\'s d = 0.58), and dissatisfaction for daily life subscale (p = 0.012, Cohen\'s d = 0.56).
CONCLUSIONS: DT after LPG is a valuable reconstruction technique with satisfactory surgical outcomes, especially regarding reduced reflux symptoms, improving the postoperative nutritional status and QOL.
METHODS: This study enrolled 164 patients who underwent LPG at the Northern Jiangsu People\'s Hospital in Jiangsu between January 2017 to January 2022 (EG: 51 patients; GT: 77 patients; DT: 36 patients). We compared the clinical and pathological characteristics, surgical features, postoperative complications, nutritional status, and quality of life (QOL) among the above three groups.
RESULTS: Mean operative time was longer with the DT group than the remaining two groups (p = 0.001). With regard to postoperative complications, considerable differences in the postoperative reflux symptoms (p = 0.042) and reflux esophagitis (p = 0.040) among the three groups were found. For the nutritional status, total protein, hemoglobin and albumin reduction rates in the GT group were significantly higher than the other two groups at 12 months postoperatively. In the PGSAS-45, three assessment items were better in the DT group significantly compared with the esophageal reflux subscale (p = 0.047, Cohen\'s d = 0.44), dissatisfaction at the meal (p = 0.009, Cohen\'s d = 0.58), and dissatisfaction for daily life subscale (p = 0.012, Cohen\'s d = 0.56).
CONCLUSIONS: DT after LPG is a valuable reconstruction technique with satisfactory surgical outcomes, especially regarding reduced reflux symptoms, improving the postoperative nutritional status and QOL.
摘要：
背景：对于近端胃切除术后的最佳重建技术尚无共识。这项研究的目的是回顾性比较食管胃造口术（EG）吻合术的手术结果，行腹腔镜近端胃切除术（LPG）的患者的胃管（GT）重建和双路（DT）重建，以阐明优越的重建方法。
方法：本研究纳入了2017年1月至2022年1月在江苏省苏北人民医院接受LPG治疗的164例患者（EG：51例；GT：77例；DT：36例）。我们比较了临床和病理特征，手术特点,术后并发症,营养状况,以上三组的生活质量（QOL）。
结果：DT组的平均手术时间长于其余两组（p=0.001）。关于术后并发症，发现三组之间的术后反流症状（p=0.042）和反流性食管炎（p=0.040）存在相当大的差异。关于营养状况，总蛋白质，术后12个月时,GT组的血红蛋白和白蛋白减少率显著高于其他两组.在PGSAS-45中，DT组的三个评估项目明显优于食管反流亚量表（p=0.047，Cohen\sd=0.44），对膳食的不满(p=0.009，科恩的d=0.58)，和对日常生活分量表的不满(p=0.012，科恩的d=0.56)。
结论：液化石油气后DT是一种有价值的重建技术，具有令人满意的手术效果，尤其是反流症状减少，改善术后营养状况和生活质量。
方法：本研究纳入了2017年1月至2022年1月在江苏省苏北人民医院接受LPG治疗的164例患者（EG：51例；GT：77例；DT：36例）。我们比较了临床和病理特征，手术特点,术后并发症,营养状况,以上三组的生活质量（QOL）。
结果：DT组的平均手术时间长于其余两组（p=0.001）。关于术后并发症，发现三组之间的术后反流症状（p=0.042）和反流性食管炎（p=0.040）存在相当大的差异。关于营养状况，总蛋白质，术后12个月时,GT组的血红蛋白和白蛋白减少率显著高于其他两组.在PGSAS-45中，DT组的三个评估项目明显优于食管反流亚量表（p=0.047，Cohen\sd=0.44），对膳食的不满(p=0.009，科恩的d=0.58)，和对日常生活分量表的不满(p=0.012，科恩的d=0.56)。
结论：液化石油气后DT是一种有价值的重建技术，具有令人满意的手术效果，尤其是反流症状减少，改善术后营养状况和生活质量。
