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Abstract：
OBJECTIVE: The aim of this study is to investigate the effect of double-tract reconstruction on short-term clinical outcome, quality of life and nutritional status of patients after proximal gastrectomy by comparing with esophagogastrostomy and total gastrectomy with Roux-en-Y reconstruction.
METHODS: The clinical data of patients who underwent double tract reconstruction (DTR), esophagogastrostomy (EG), total gastrectomy with Roux-en-Y reconstruction (TG-RY) were retrospectively collected from May 2020 to May 2022. The clinical characteristics, short-term surgical outcomes, postoperative quality of life and nutritional status were compared among the three groups.
RESULTS: Compared with the DTR group, the operation time in the TG group was significantly shorter (200(180,240) minutes vs. 230(210,255) minutes, p < 0.01), and more lymph nodes were removed (28(22, 25) vs. 22(19.31), p < 0.01), there were no significant differences in intraoperative blood loss, first flatus time, postoperative hospital stay and postoperative complication rate among the three groups. Postoperative digestive tract angiography was completed in 36 patients in the DTR group, of which 21 (58.3%) showed double-tract type of food passing. The incidence of postoperative reflux symptoms was 9.2% in the DTR group, 43.8% in the EG group and 23.2% in the TG group, repectively (P < 0.01). EORTCQLQ-STO22 questionnaire survey showed that compared with EG group, DTR group had fewer reflux symptoms (P < 0.05), fewer anxiety symptoms (P < 0.05) and more swallowing symptoms (P < 0.05). Compared with TG group, DTR group had fewer reflux symptoms (P < 0.05). There were no other significant differences between the two groups. Compared with TG group and EG group, DTR can better maintain postoperative BMI, and there is no statistical difference between the three groups in terms of hemoglobin and albumin.
CONCLUSIONS: Although partial double-tract reconstruction approach does not always ensure food to enter the distal jejunum along the two pathways as expected, it still shows satisfactory anti-reflux effect. Moreover, it might improve patients\' quality of life and maintain better nutritional status comparing with gastroesophageal anastomosis and total gastrectomy with Roux-en-Y reconstruction.
METHODS: The clinical data of patients who underwent double tract reconstruction (DTR), esophagogastrostomy (EG), total gastrectomy with Roux-en-Y reconstruction (TG-RY) were retrospectively collected from May 2020 to May 2022. The clinical characteristics, short-term surgical outcomes, postoperative quality of life and nutritional status were compared among the three groups.
RESULTS: Compared with the DTR group, the operation time in the TG group was significantly shorter (200(180,240) minutes vs. 230(210,255) minutes, p < 0.01), and more lymph nodes were removed (28(22, 25) vs. 22(19.31), p < 0.01), there were no significant differences in intraoperative blood loss, first flatus time, postoperative hospital stay and postoperative complication rate among the three groups. Postoperative digestive tract angiography was completed in 36 patients in the DTR group, of which 21 (58.3%) showed double-tract type of food passing. The incidence of postoperative reflux symptoms was 9.2% in the DTR group, 43.8% in the EG group and 23.2% in the TG group, repectively (P < 0.01). EORTCQLQ-STO22 questionnaire survey showed that compared with EG group, DTR group had fewer reflux symptoms (P < 0.05), fewer anxiety symptoms (P < 0.05) and more swallowing symptoms (P < 0.05). Compared with TG group, DTR group had fewer reflux symptoms (P < 0.05). There were no other significant differences between the two groups. Compared with TG group and EG group, DTR can better maintain postoperative BMI, and there is no statistical difference between the three groups in terms of hemoglobin and albumin.
CONCLUSIONS: Although partial double-tract reconstruction approach does not always ensure food to enter the distal jejunum along the two pathways as expected, it still shows satisfactory anti-reflux effect. Moreover, it might improve patients\' quality of life and maintain better nutritional status comparing with gastroesophageal anastomosis and total gastrectomy with Roux-en-Y reconstruction.
摘要：
目的：本研究的目的是探讨双道重建术对短期临床结果的影响，通过与食管胃吻合术和Roux-en-Y重建全胃切除术比较，可以改善近端胃切除术后患者的生活质量和营养状况。
方法：接受双路重建术（DTR）的患者的临床资料，食管胃造口术（EG），回顾性收集了2020年5月至2022年5月的全胃切除术和Roux-en-Y重建术(TG-RY).临床特点,短期手术结果，比较三组患者术后生活质量和营养状况。
结果：与DTR组相比，TG组手术时间明显缩短(200(180,240)分钟vs.230（210,255）分钟，p<0.01),和更多的淋巴结被删除（28（22，25）与22(19.31),p<0.01),术中失血量无显著差异,第一次排气时间，术后住院时间及术后并发症发生率。DTR组36例患者完成术后消化道造影,其中21人(58.3%)显示双道型食物通过。DTR组术后反流症状发生率为9.2%,EG组为43.8%,TG组为23.2%,分别为(P<0.01)。EORTCQLQ-STO22问卷调查显示,与EG组相比,DTR组有较少的反流症状(P<0.05),焦虑症状较少(P<0.05),吞咽症状较多(P<0.05)。与TG组相比，DTR组有较少的反流症状(P<0.05)。两组之间无其他显著性差异。与TG组和EG组相比，DTR能较好地维持术后BMI,在血红蛋白和白蛋白方面，三组之间没有统计学差异。
结论：尽管部分双束重建方法并不总能确保食物如预期的那样沿着两条途径进入远端空肠，它仍然显示令人满意的抗反流效果。此外，与胃食管吻合术和Roux-en-Y重建全胃切除术相比，它可以改善患者的生活质量并保持更好的营养状况。
方法：接受双路重建术（DTR）的患者的临床资料，食管胃造口术（EG），回顾性收集了2020年5月至2022年5月的全胃切除术和Roux-en-Y重建术(TG-RY).临床特点,短期手术结果，比较三组患者术后生活质量和营养状况。
结果：与DTR组相比，TG组手术时间明显缩短(200(180,240)分钟vs.230（210,255）分钟，p<0.01),和更多的淋巴结被删除（28（22，25）与22(19.31),p<0.01),术中失血量无显著差异,第一次排气时间，术后住院时间及术后并发症发生率。DTR组36例患者完成术后消化道造影,其中21人(58.3%)显示双道型食物通过。DTR组术后反流症状发生率为9.2%,EG组为43.8%,TG组为23.2%,分别为(P<0.01)。EORTCQLQ-STO22问卷调查显示,与EG组相比,DTR组有较少的反流症状(P<0.05),焦虑症状较少(P<0.05),吞咽症状较多(P<0.05)。与TG组相比，DTR组有较少的反流症状(P<0.05)。两组之间无其他显著性差异。与TG组和EG组相比，DTR能较好地维持术后BMI,在血红蛋白和白蛋白方面，三组之间没有统计学差异。
结论：尽管部分双束重建方法并不总能确保食物如预期的那样沿着两条途径进入远端空肠，它仍然显示令人满意的抗反流效果。此外，与胃食管吻合术和Roux-en-Y重建全胃切除术相比，它可以改善患者的生活质量并保持更好的营养状况。
