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Abstract：
BACKGROUND: With the continuous progress of surgical technology and improvements in medical standards, the treatment of gastric cancer surgery is also evolving. Proximal gastrectomy is a common treatment, but double-channel anastomosis and tubular gastroesophageal anastomosis have attracted much attention in terms of surgical options. Each of these two surgical methods has advantages and disadvantages, so it is particularly important to compare and analyze their clinical efficacy and safety.
OBJECTIVE: To compare the surgical safety, clinical efficacy, and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in proximal gastrectomy.
METHODS: The clinical and follow-up data of 99 patients with proximal gastric cancer who underwent proximal gastrectomy and were admitted to our hospital between January 2018 and September 2023 were included in this retrospective cohort study. According to the different anastomosis methods used, the patients were divided into a double-channel anastomosis group (50 patients) and a tubular gastroesophageal anastomosis group (49 patients). In the double-channel anastomosis, Roux-en-Y anastomosis of the esophagus and jejunum was performed after proximal gastric dissection, and then side-to-side anastomosis was performed between the residual stomach and jejunum to establish an antireflux barrier and reduce postoperative gastroesophageal reflux. In the tubular gastroesophageal anastomosis group, after the proximal end of the stomach was cut, tubular gastroplasty was performed on the distal stump of the stomach and a linear stapler was used to anastomose the posterior wall of the esophagus and the anterior wall of the stomach tube. The main outcome measure was quality of life 1 year after surgery in both groups, and the evaluation criteria were based on the postgastrectomy syndrome assessment scale. The greater the changes in body mass, food intake per meal, meal quality subscale score, and total measures of physical and mental health score, the better the condition; the greater the other indicators, the worse the condition. The secondary outcome measures were intraoperative and postoperative conditions, the incidence of postoperative long-term complications, and changes in nutritional status at 1, 3, 6, and 12 months after surgery.
RESULTS: In the double-channel anastomosis cohort, there were 35 males (70%) and 15 females (30%), 33 (66.0%) were under 65 years of age, and 37 (74.0%) had a body mass index ranging from 18 to 25 kg/m2. In the group undergoing tubular gastroesophageal anastomosis, there were eight females (16.3%), 21 (42.9%) individuals were under the age of 65 years, and 34 (69.4%) had a body mass index ranging from 18 to 25 kg/m2. The baseline data did not significantly differ between the two groups (P > 0.05 for all), with the exception of age (P = 0.021). The duration of hospitalization, number of lymph nodes dissected, intraoperative blood loss, and perioperative complication rate did not differ significantly between the two groups (P > 0.05 for all). Patients in the dual-channel anastomosis group scored better on quality of life measures than did those in the tubular gastroesophageal anastomosis group. Specifically, they had lower scores for esophageal reflux [2.8 (2.3, 4.0) vs 4.8 (3.8, 5.0), Z = 3.489, P < 0.001], eating discomfort [2.7 (1.7, 3.0) vs 3.3 (2.7, 4.0), Z = 3.393, P = 0.001], total symptoms [2.3 (1.7, 2.7) vs 2.5 (2.2, 2.9), Z = 2.243, P = 0.025], and other aspects of quality of life. The postoperative symptoms [2.0 (1.0, 3.0) vs 2.0 (2.0, 3.0), Z = 2.127, P = 0.033], meals [2.0 (1.0, 2.0) vs 2.0 (2.0, 3.0), Z = 3.976, P < 0.001], work [1.0 (1.0, 2.0) vs 2.0 (1.0, 2.0), Z = 2.279, P = 0.023], and daily life [1.7 (1.3, 2.0) vs 2.0 (2.0, 2.3), Z = 3.950, P < 0.001] were all better than those of the tubular gastroesophageal anastomosis group. The group that underwent tubular gastroesophageal anastomosis had a superior anal exhaust score [3.0 (2.0, 4.0) vs 3.5 (2.0, 5.0) (Z = 2.345, P = 0.019] compared to the dual-channel anastomosis group. Hemoglobin, serum albumin, total serum protein, and the rate at which body mass decreased one year following surgery did not differ significantly between the two groups (P > 0.05 for all).
CONCLUSIONS: The safety of double-channel anastomosis in proximal gastric cancer surgery is equivalent to that of tubular gastric surgery. Compared with tubular gastric surgery, double-channel anastomosis is a preferred surgical technique for proximal gastric cancer. It offers advantages such as less esophageal reflux and improved quality of life.
OBJECTIVE: To compare the surgical safety, clinical efficacy, and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in proximal gastrectomy.
METHODS: The clinical and follow-up data of 99 patients with proximal gastric cancer who underwent proximal gastrectomy and were admitted to our hospital between January 2018 and September 2023 were included in this retrospective cohort study. According to the different anastomosis methods used, the patients were divided into a double-channel anastomosis group (50 patients) and a tubular gastroesophageal anastomosis group (49 patients). In the double-channel anastomosis, Roux-en-Y anastomosis of the esophagus and jejunum was performed after proximal gastric dissection, and then side-to-side anastomosis was performed between the residual stomach and jejunum to establish an antireflux barrier and reduce postoperative gastroesophageal reflux. In the tubular gastroesophageal anastomosis group, after the proximal end of the stomach was cut, tubular gastroplasty was performed on the distal stump of the stomach and a linear stapler was used to anastomose the posterior wall of the esophagus and the anterior wall of the stomach tube. The main outcome measure was quality of life 1 year after surgery in both groups, and the evaluation criteria were based on the postgastrectomy syndrome assessment scale. The greater the changes in body mass, food intake per meal, meal quality subscale score, and total measures of physical and mental health score, the better the condition; the greater the other indicators, the worse the condition. The secondary outcome measures were intraoperative and postoperative conditions, the incidence of postoperative long-term complications, and changes in nutritional status at 1, 3, 6, and 12 months after surgery.
RESULTS: In the double-channel anastomosis cohort, there were 35 males (70%) and 15 females (30%), 33 (66.0%) were under 65 years of age, and 37 (74.0%) had a body mass index ranging from 18 to 25 kg/m2. In the group undergoing tubular gastroesophageal anastomosis, there were eight females (16.3%), 21 (42.9%) individuals were under the age of 65 years, and 34 (69.4%) had a body mass index ranging from 18 to 25 kg/m2. The baseline data did not significantly differ between the two groups (P > 0.05 for all), with the exception of age (P = 0.021). The duration of hospitalization, number of lymph nodes dissected, intraoperative blood loss, and perioperative complication rate did not differ significantly between the two groups (P > 0.05 for all). Patients in the dual-channel anastomosis group scored better on quality of life measures than did those in the tubular gastroesophageal anastomosis group. Specifically, they had lower scores for esophageal reflux [2.8 (2.3, 4.0) vs 4.8 (3.8, 5.0), Z = 3.489, P < 0.001], eating discomfort [2.7 (1.7, 3.0) vs 3.3 (2.7, 4.0), Z = 3.393, P = 0.001], total symptoms [2.3 (1.7, 2.7) vs 2.5 (2.2, 2.9), Z = 2.243, P = 0.025], and other aspects of quality of life. The postoperative symptoms [2.0 (1.0, 3.0) vs 2.0 (2.0, 3.0), Z = 2.127, P = 0.033], meals [2.0 (1.0, 2.0) vs 2.0 (2.0, 3.0), Z = 3.976, P < 0.001], work [1.0 (1.0, 2.0) vs 2.0 (1.0, 2.0), Z = 2.279, P = 0.023], and daily life [1.7 (1.3, 2.0) vs 2.0 (2.0, 2.3), Z = 3.950, P < 0.001] were all better than those of the tubular gastroesophageal anastomosis group. The group that underwent tubular gastroesophageal anastomosis had a superior anal exhaust score [3.0 (2.0, 4.0) vs 3.5 (2.0, 5.0) (Z = 2.345, P = 0.019] compared to the dual-channel anastomosis group. Hemoglobin, serum albumin, total serum protein, and the rate at which body mass decreased one year following surgery did not differ significantly between the two groups (P > 0.05 for all).
CONCLUSIONS: The safety of double-channel anastomosis in proximal gastric cancer surgery is equivalent to that of tubular gastric surgery. Compared with tubular gastric surgery, double-channel anastomosis is a preferred surgical technique for proximal gastric cancer. It offers advantages such as less esophageal reflux and improved quality of life.
摘要：
背景：随着外科技术的不断进步和医疗标准的提高，胃癌手术的治疗也在不断发展。近端胃切除术是一种常见的治疗方法，但双通道吻合和管状胃食管吻合在手术选择方面备受关注。这两种手术方法各有优缺点,因此对其临床疗效和安全性进行比较分析就显得尤为重要。
目的：为了比较手术安全性，临床疗效,双通道吻合和管状胃食管吻合在近端胃切除术中的安全性。
方法：纳入2018年1月至2023年9月我院收治的99例近端胃癌患者的临床及随访资料。根据所采用的吻合方法的不同,将患者分为双通道吻合组(50例)和管状胃食管吻合组(49例).在双通道吻合中，近端胃解剖后进行食管和空肠的Roux-en-Y吻合术，然后在残胃和空肠之间进行侧侧吻合，以建立抗反流屏障并减少术后胃食管反流。在管状胃食管吻合术组中，在胃的近端被切开后，在胃的远端残端进行管状胃成形术，并使用线性吻合器吻合食管的后壁和胃管的前壁。两组患者手术后1年的主要结局指标是生活质量,评价标准采用胃切除术后综合征评定量表。体重变化越大，每餐的食物摄入量，膳食质量子量表评分，以及身体和心理健康评分的总指标，条件越好；其他指标越大，情况越糟。次要结果指标是术中和术后情况，术后长期并发症的发生率，术后1、3、6和12个月的营养状况变化。
结果：在双通道吻合队列中，有35名男性（70％）和15名女性（30％），33人(66.0%)年龄在65岁以下，37（74.0％）的体重指数为18至25kg/m2。在接受管状胃食管吻合术的组中，有八名女性(16.3%)，21人(42.9%)年龄在65岁以下，和34（69.4％）的体重指数在18至25kg/m2之间。两组患者基线资料差异无统计学意义(均P>0.05),年龄除外（P=0.021）。住院时间,解剖的淋巴结数量，术中失血,围手术期并发症发生率两组间差异无统计学意义(均P>0.05)。双通道吻合组患者的生活质量评分优于管状胃食管吻合组。具体来说,他们的食管反流得分较低[2.8（2.3，4.0）vs4.8（3.8，5.0），Z=3.489,P<0.001],进食不适[2.7（1.7，3.0）vs3.3（2.7，4.0），Z=3.393,P=0.001],总症状[2.3（1.7，2.7）vs2.5（2.2，2.9），Z=2.243,P=0.025],和其他方面的生活质量。术后症状[2.0（1.0，3.0）vs2.0（2.0，3.0），Z=2.127,P=0.033],膳食[2.0（1.0，2.0）vs2.0（2.0，3.0），Z=3.976,P<0.001],工作[1.0（1.0，2.0）对2.0（1.0，2.0），Z=2.279,P=0.023],和日常生活[1.7（1.3，2.0）对2.0（2.0，2.3），Z=3.950,P<0.001]均优于管状胃食管吻合术组。与双通道吻合术组相比，接受管状胃食管吻合术组的肛门排气评分[3.0（2.0，4.0）比3.5（2.0，5.0）（Z=2.345，P=0.019]。血红蛋白,血清白蛋白,血清总蛋白，两组术后1年体质量下降率无显著差异(均P>0.05)。
结论：双通道吻合在近端胃癌手术中的安全性与管状胃手术相当。与管状胃手术相比，双通道吻合是近端胃癌的首选手术方法。它具有减少食管反流和提高生活质量等优点。
目的：为了比较手术安全性，临床疗效,双通道吻合和管状胃食管吻合在近端胃切除术中的安全性。
方法：纳入2018年1月至2023年9月我院收治的99例近端胃癌患者的临床及随访资料。根据所采用的吻合方法的不同,将患者分为双通道吻合组(50例)和管状胃食管吻合组(49例).在双通道吻合中，近端胃解剖后进行食管和空肠的Roux-en-Y吻合术，然后在残胃和空肠之间进行侧侧吻合，以建立抗反流屏障并减少术后胃食管反流。在管状胃食管吻合术组中，在胃的近端被切开后，在胃的远端残端进行管状胃成形术，并使用线性吻合器吻合食管的后壁和胃管的前壁。两组患者手术后1年的主要结局指标是生活质量,评价标准采用胃切除术后综合征评定量表。体重变化越大，每餐的食物摄入量，膳食质量子量表评分，以及身体和心理健康评分的总指标，条件越好；其他指标越大，情况越糟。次要结果指标是术中和术后情况，术后长期并发症的发生率，术后1、3、6和12个月的营养状况变化。
结果：在双通道吻合队列中，有35名男性（70％）和15名女性（30％），33人(66.0%)年龄在65岁以下，37（74.0％）的体重指数为18至25kg/m2。在接受管状胃食管吻合术的组中，有八名女性(16.3%)，21人(42.9%)年龄在65岁以下，和34（69.4％）的体重指数在18至25kg/m2之间。两组患者基线资料差异无统计学意义(均P>0.05),年龄除外（P=0.021）。住院时间,解剖的淋巴结数量，术中失血,围手术期并发症发生率两组间差异无统计学意义(均P>0.05)。双通道吻合组患者的生活质量评分优于管状胃食管吻合组。具体来说,他们的食管反流得分较低[2.8（2.3，4.0）vs4.8（3.8，5.0），Z=3.489,P<0.001],进食不适[2.7（1.7，3.0）vs3.3（2.7，4.0），Z=3.393,P=0.001],总症状[2.3（1.7，2.7）vs2.5（2.2，2.9），Z=2.243,P=0.025],和其他方面的生活质量。术后症状[2.0（1.0，3.0）vs2.0（2.0，3.0），Z=2.127,P=0.033],膳食[2.0（1.0，2.0）vs2.0（2.0，3.0），Z=3.976,P<0.001],工作[1.0（1.0，2.0）对2.0（1.0，2.0），Z=2.279,P=0.023],和日常生活[1.7（1.3，2.0）对2.0（2.0，2.3），Z=3.950,P<0.001]均优于管状胃食管吻合术组。与双通道吻合术组相比，接受管状胃食管吻合术组的肛门排气评分[3.0（2.0，4.0）比3.5（2.0，5.0）（Z=2.345，P=0.019]。血红蛋白,血清白蛋白,血清总蛋白，两组术后1年体质量下降率无显著差异(均P>0.05)。
结论：双通道吻合在近端胃癌手术中的安全性与管状胃手术相当。与管状胃手术相比，双通道吻合是近端胃癌的首选手术方法。它具有减少食管反流和提高生活质量等优点。
