背景:近年来,胃癌的发病率明显上升。手术切除是主要治疗手段,但胃癌术后消化道重建的方法仍存在争议。在目前的研究中,探讨合理的消化道重建方法,提高术后患者的生活质量和营养状况。为此,我们对胃癌患者行空肠间置术双道重建术(DTR)和食管空肠Roux-en-Y重建术(RY)的临床结果进行统计分析。
目的:探讨DTR在全腹腔镜胃癌根治术(TLTG)中的应用效果,并评价其安全性和有效性。
方法:收集2021年10月至2023年1月在河北医科大学第四医院接受TLTG治疗的77例患者的相关资料。其中,35例采用DTR治疗,其余42例采用传统RY治疗。1:1倾向评分匹配后,将病例分为每组31例,具有均匀分布的数据。对两组患者的临床特点及近期、远期临床结局进行统计学分析。
结果:两组基本资料无显著差异,术中失血,淋巴结清扫的数量,术后首次排便时间,术后住院时间,术后并发症,和1日的实验室检查结果,3rd,手术后第5天。DTR组手术时间长于RY组[(307.58±65.14)minvs(272.45±62.09)min,P=0.016],但是DTR组的液体食物的首次摄入量短于RY组[(4.45±1.18)dvs(6.0±5.18)d,P=0.028]。DTR组的反流性烧心(Visick分级)和术后胆囊疾病发生率低于RY组(P=0.033和P=0.038)。虽然体重没有显著差异,血红蛋白,前白蛋白,两组在术后1、3和6个月时的白蛋白,DTR组患者的饮食优于RY组(P=0.031)。
结论:DTR在TLTG中的临床效果优于RY,表明它是腹腔镜胃癌手术中一种更有价值的消化道重建方法。
BACKGROUND: The incidence of gastric cancer has significantly increased in recent years. Surgical resection is the main treatment, but the method of digestive tract reconstruction after gastric cancer surgery remains controversial. In the current study, we sought to explore a reasonable method of digestive tract reconstruction and improve the quality of life and nutritional status of patients after surgery. To this end, we statistically analyzed the clinical results of patients with gastric cancer who underwent jejunal interposition double-tract reconstruction (DTR) and esophageal jejunum Roux-en-Y reconstruction (RY).
OBJECTIVE: To explore the application effect of DTR in total laparoscopic radical total gastrectomy (TLTG) and evaluate its safety and efficacy.
METHODS: We collected the relevant data of 77 patients who underwent TLTG at the Fourth Hospital of Hebei Medical University from October 2021 to January 2023. Among them, 35 cases were treated with DTR, and the remaining 42 cases were treated with traditional RY. After 1:1 propensity score matching, the cases were grouped into 31 cases per group, with evenly distributed data. The clinical characteristics and short- and long-term clinical outcomes of the two groups were statistically analyzed.
RESULTS: The two groups showed no significant differences in basic data, intraoperative blood loss, number of lymph node dissections, first defecation time after operation, postoperative hospital stay, postoperative complications, and laboratory examination results on the 1st, 3rd, and 5th days after operation. The operation time of the DTR group was longer than that of the RY group [(307.58 ± 65.14) min vs (272.45 ± 62.09) min, P = 0.016], but the first intake of liquid food in the DTR group was shorter than that in the RY group [(4.45 ± 1.18) d vs (6.0 ± 5.18) d, P = 0.028]. The incidence of reflux heartburn (Visick grade) and postoperative gallbladder disease in the DTR group was lower than that in the RY group (P = 0.033 and P = 0.038). Although there was no significant difference in body weight, hemoglobin, prealbumin, and albumin between the two groups at 1,3 and 6 months after surgery, the diet of patients in the DTR group was better than that in the RY group (P = 0.031).
CONCLUSIONS: The clinical effect of DTR in TLTG is better than that of RY, indicating that it is a more valuable digestive tract reconstruction method in laparoscopic gastric cancer surgery.