腹腔镜辅助下Overlap法管型胃食管吻合在食管胃结合部腺癌中临床疗效分析

目的探讨腹腔镜辅助下Overlap法管型胃食管吻合在Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌(adenocarcinoma of the esophagogastfic junction，AEG)中临床应用疗效。 方法回顾性分析江苏省苏北人民医院胃肠中心2018年1月至2020年4月30例行腹腔镜辅助下近端胃切除的Siewert Ⅱ型和Ⅲ型AEG患者临床资料。2019年5月以前的18例行传统食管胃吻合(A组)，2019年5月及以后的12例行Overlap法管型胃食管吻合(B组)。应用SPSS 19.0统计软件进行分析，患者的一般资料、围手术期指标及术后反流性疾病问卷表(reflux diagnostic questionnaire，RDQ)评分等计量资料以均数±标准差( ±s)表示，两两比较采用t检验；术后胃食管反流病(gastroesophageal reflux disease，GERD)、反流性食管炎(reflux esophagitis，RE)等计数指标比较采用χ²检验，P<0.05为差异有统计学意义。 结果A组与B组的术后1、3个月RDQ评分分别为(13.83±5.09)分比(9.08±3.63)分、(13.16±4.97)分比(8.67±3.68)分。2组的术后1、3个月诊断为GERD的患者分别为9例比2例、10例比2例，经胃镜证实术后RE为A组7例、B组1例；术后RDQ评分B组均低于A组，差异有统计学意义(P<0.05)。2组术后RE及GERD发生率比较，B组明显低于A组，但差异无统计学意义(P>0.05)。 结论腹腔镜辅助下Overlap法管型胃食管吻合较传统胃食管吻合具有更好的抗术后反流的疗效，且创伤小，操作简单安全，值得临床推广应用。

Laparoscopic-assisted Overlap tube gastroesophageal anastomosis in the treatment of adenocarcinoma of the esophagogastric junction

ObjectiveTo investigate the clinical effect of Overlap tube gastroesophageal anastomosis with laparoscopic assistance in Siewert typeⅡ and Ⅲ esophagogastric junction adenocarcinoma (AEG). MethodsThe clinical data of 30 patients with Siewert type Ⅱ and type Ⅲ AEG who underwent laparoscopic-assisted proximal gastrectomy from Jan. 2018 to Apr. 2020 in the Gastrointestinal Center, Subei People′s Hospital of Jiangsu Province were retrospectively analyzed. Among them, 18 cases of traditional esophagogastric anastomosis (group A) were performed before May 2019, and 12 cases of Overlap tube gastroesophageal anastomosis (group B) were performed in May 2019 and after. SPSS 19.0 statistical software was used for analysis. Measurement data such as general patient data, perioperative indicators and postoperative reflux questionnaire (RDQ) scores were expressed as ±s, and pairwise comparisons were performed by t test; postoperative gastroesophagus reflux disease (GERD), reflux esophagitis (RE) and other counting indicators were compared using the χ² test, and P<0.05 was considered statistically significant. ResultsThe RDQ scores of the traditional group and the tube stomach group were (13.83±5.09) points vs (9.08±3.63) points and (13.16±4.97) points vs (8.67±3.68) points at 1 month and 3 months after operation. The number of GERD diagnosed in the two groups at 1 month and 3 months after operation were (9 cases vs 2 cases) and (10 cases vs 2 cases). Gastroscopy confirmed that there were 7 cases of RE in the traditional group and 1 case in the tube-gastric group. Postoperative RDQ scores of patients in the tube-gastric group were lower than those in the traditional group, and the difference was statistically significant (P<0.05). In the comparison of postoperative RE and GERD incidence, the tube-gastric group was significantly lower than the traditional group, but the difference between the two groups was not statistically significant (P>0.05). ConclusionsCompared with traditional gastroesophageal anastomosis, the Overlap tube gastroesophageal anastomosis with laparoscopic-assisted has a better effect on anti-reflux after surgery, and the traumat is relatively small, the operation is simple and safe, and it is worthy of clinical promotion.