腹腔镜辅助下三种消化道重建方式在食管胃结合部腺癌中的临床疗效分析

目的研究腹腔镜辅助下近端胃切除3种不同消化道重建方式治疗SiewertⅡ型和Siewert Ⅲ型食管胃结合部腺癌(adenocarcinoma of the esophagogastfic junction,AEG)临床疗效。 方法回顾性分析2016年1月至2018年12月江苏省苏北人民医院收治的93例Siewert Ⅱ型和Siewert Ⅲ型AEG患者资料。根据消化道重建方式不同分为3组,其中31例行食管残胃吻合术(A组)、33例行双通道空肠间置术(B组)、29例行单通道空肠间置术(C组)。采用SPSS 19.0软件进行数据分析。围手术期指标以均数±标准差表示,3组间的计量资料比较采用单因素方差分析,组间两两比较采用t检验,术后并发症发生率等采用χ²检验。P<0.05为差异有统计学意义。 结果3组患者均顺利完成手术,无围手术期死亡病例。B、C组的手术时间长于A组(P<0.05);术后短期营养状况(血清总蛋白、血红蛋白、血清白蛋白)比较,B、C组均优于A组(P<0.05);3组患者的术后反流性食管炎(reflux esophagitis,RE)发生率分别为35.5%、3.0%、0.0%,差异有统计学意义(P<0.05)。 结论腹腔镜辅助下近端胃切除的AEG患者行空肠间置术(双通道、单通道吻合)较传统食管残胃吻合术具有更好的术后短期营养状况及较少的术后并发症,尤其在RE方面,空肠间置术具有明显优势,是AEG行近端胃切除患者理想消化道重建方式。

Analysis of clinical efficacy of three laparoscopic assisted digestive tract reconstruction methods in esophagogastric junction adenocarcinoma

ObjectiveTo study the clinical efficacy of laparoscopic-assisted proximal gastrectomy for three different digestive tract reconstruction methods in the treatment of Siewert Ⅱ and Siewert Ⅲ esophagogastric junction adenocarcinoma (AEG). MethodsA retrospective analysis of the data of 93 Siewert type Ⅱ and Siewert type Ⅲ AEG patients admitted to the Subei People’s Hospital of Jiangsu Province from Jan. 2016 to Dec. 2018. Divided into three groups according to different ways of digestive tract reconstruction. Among them, 31 esophagogastrostomy (group A), 33 double tract reconstruction (group B)and 29 single-canal jejunum interposition (group C). Data analysis was performed using SPSS 19.0 software. The perioperative indicators were showed by ( ±s). The measurement data comparison between the three groups was analyzed by single factor analysis of variance. The pairwise comparison between groups was performed by t test. The incidence of postoperative complications was measured by χ² test. P<0.05 was considered statistically significant. ResultsThe three groups of patients successfully completed the operation without perioperative deaths. The operation time of group B and C was longer than that of group A (P<0.05). Compared with postoperative short-term nutritional status (total serum protein, serum albumin, hemoglobin), group B and C were better than group A (P<0.05). The incidences of reflux esophagitis(RE) were 35.5%, 3.0%, and 0.0%, respectively, and the differences were statistically significant (P<0.05). ConclusionsLaparoscopic-assisted proximal gastrectomy in patients with AEG undergoing jejunal interposition (double tract reconstruction, single-canal jejunum interposition) has better short-term postoperative nutritional status and fewer postoperative complications than traditional esophagogastrostomy, especially in terms of RE, jejunal interposition has obvious advantages, which is an ideal way to reconstruct the digestive tract in patients with AEG undergoing proximal gastrectomy.