Efficacy of Double Tract Reconstruction of Proximal Gastrectomy and Radical Total Gastrectomy of Upper Gastric Cancer
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摘要:
目的 研究近端胃切除双通道重建及根治性全胃切除术用于胃上部癌的疗效。 方法 纳入2014年4月至2019年4月于上海交通大学医学院附属苏州九龙医院择期拟行胃上部癌根治术患者50例为研究对象，随机分为2组。观察组（25例）行根治性近端胃切除双通道重建术；对照组（25例）行根治性全胃切除术。观察2组术中出血量、手术时间、术后肛门排气时间、术后进食时间、术后下床活动时间及术后住院时间，比较2组术后并发症发生情况，并分析2组术前及术后6个月单次进食量、体质量及血清胃蛋白酶Ⅰ型与Ⅱ型比值、血清胃泌素、血红蛋白、血浆白蛋白水平。 结果 观察组术中出血量、手术时间、术后下床活动时间、术后住院时间均显著低于对照组（P < 0.05）；术后肛门首次排气时间及术后进食时间组间比较，差异无统计学意义（P > 0.05）。2组不良反应发生率分别为20.00%、36.00%，2组比较，差异无统计学意义（P > 0.05）。2组术后6个月单次进食量、血清胃泌素、血清胃蛋白酶Ⅰ型/Ⅱ型均显著低于术前（P < 0.05）；观察组术后6个月血清胃泌素显著高于对照组（P < 0.05），单次进食量、血清胃蛋白酶Ⅰ型/Ⅱ型较对照组比较，差异无统计学意义（P > 0.05）。2组术后6个月血红蛋白、血浆白蛋白、体质量均显著低于术前（P < 0.05）；观察组术后6个月血红蛋白、血浆白蛋白、体质量均显著高于对照组（P < 0.05）。 结论 近端胃切除双通道重建术保留了胃及十二指肠相关生理功能，患者远期营养状况较好，且手术难度小、创伤小、安全性较好，临床应引起足够重视。 -
关键词:
- 胃上部癌 /
- 近端胃切除双通道重建 /
- 并发症
Abstract:Objective To study the efficacy of proximal gastrectomy with double tract reconstruction and total radical gastrectomy for upper gastric cancer. Methods 50 patients who underwent radical resection of upper gastric cancer in Suzhou Jiulong Hospital from April 2014 to April 2019 were included in the study and were randomly divided into two groups. Observation group （25 cases） underwent radical proximal gastrectomy and double-tract reconstruction, and control group （25 cases） underwent total radical gastrectomy. Intraoperative blood loss, operation time, postoperative anal exhaust time, postoperative feeding time, postoperative ambulance time and postoperative hospitalization were observed and recorded in the two groups. The incidence of postoperative complications, single food intake, body weight, the ratio of serum pepsin type Ⅰ to Ⅱ, serum gastrin, hemoglobin and plasma albumin were compared between the two groups before and 6 months after operation. Results The intraoperative blood loss, operation time, postoperative ambulation time and postoperative hospitalization in the observation group were significantly lower than those in the control group （P < 0.05）; there was no significant difference in the first anal exhaust time and postoperative eating time between the two groups （P > 0.05）. The incidence of adverse reactions in the two groups were 20.00% and 36.00%, respectively. There was no significant difference between the two groups （P > 0.05）. 6 months after operation, amount of food intake per meal, serum gastrin, serum pepsin typeⅠ/Ⅱ were significantly lower than those before operation （P < 0.05）. Six months after operation, the serum gastrin in observation group was significantly higher than that in control group （P < 0.05）, and there was no statistical significance in the amount of food intake per meal and the pepsin typeⅠ/Ⅱ of serum compared with control group （P > 0.05）. The hemoglobin, plasma albumin and body mass at 6 months after operation in the two groups were significantly lower than those before operation （P < 0.05）; the hemoglobin, plasma albumin and body mass of the observation group at 6 months after operation were significantly higher than those of the control group （P < 0.05）. Conclusion Double tract reconstruction of proximal gastrectomy preserved function of the stomach and duodenum, so the patient has a better long-term nutritional status. The operation procedure is relatively easy causing less injury to patients. Therefore, it is an ideal way to reconstruct digestive tract in the radical operation of upper gastric carcinoma. -
表 1 两组一般资料比较[（
$\bar x \pm s$ ），n（%）]Table 1. Comparison of general information between the two groups [（
$\bar x \pm s$ ），n（%）]指标 观察组（n = 25） 对照组（n = 25） χ2/t P 年龄（岁） 62.31 ± 6.12 61.86 ± 6.24 0.257 0.798 男性 17（68.00） 16（64.00） 0.089 0.765 体质量指数（kg/m2） 22.64 ± 1.45 21.92 ± 1.50 1.726 0.091 组织学分型 腺癌 20（80.00） 21（84.00） 0.136 0.713 非腺癌 5（20.00） 4（16.00） 分化程度 低分化 17（68.00） 18（72.00） 0.095 0.758 高中分化 8（32.00） 7（28.00） pTNM分期 Ⅰ期 4（16.00） 5（20.00） 0.329 0.948 Ⅱ期 9（36.00） 7（28.00） Ⅲ期 12（48.00） 13（52.00） 
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表 2 2组手术相关指标比较（
$\bar x \pm s$ ）Table 2. Comparison of operation related indexes between the two groups （
$\bar x \pm s$ ）组别 手术
时间（min）术中
出血量（mL）术后肛门首次
排气时间（h）术后进食
时间（h）术后下床活动
时间（h）术后住院
时间（d）观察组（n = 25） 176.34 ± 14.61 112.34 ± 23.61 27.34 ± 11.27 37.84 ± 8.85 52.67 ± 11.58 8.96 ± 1.73 对照组（n = 25） 208.61 ± 16.37 148.94 ± 27.86 26.76 ± 12.08 38.15 ± 8.96 59.84 ± 11.21 11.64 ± 2.63 t 7.354 5.011 0.176 0.123 2.224 4.257 P < 0.001 < 0.001 0.861 0.903 0.031 < 0.001
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表 3 2组术后并发症发生率比较[n（%）]
Table 3. Comparison of the incidence of postoperative complications between the two groups [n（%）]
组别 n 吻合口瘘 吻合口狭窄 肺部感染 肠梗阻 胃食管反流 烧心 倾倒综合征 总计 观察组 25 1（4.00） 0（0.00） 0（0.00） 1（4.00） 2（8.00） 0（0.00） 1（4.00） 5（20.00） 对照组 25 1（4.00） 3（12.00） 1（4.00） 2（8.00） 0（0.00） 1（4.00） 1（4.00） 9（36.00）
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表 4 2组术前及术后6个月胃肠消化功能比较（
$\bar x \pm s$ ）Table 4. Comparison of gastrointestinal digestive function between the two groups before and 6 months after operation （
$\bar x \pm s $ ）组别 单次进食量（mL） 血清胃泌素（pmol/L） 血清胃蛋白酶Ⅰ型/Ⅱ型 术前 术后6个月 术前 术后6个月 术前 术后6个月 观察组（n = 25） 1126.21 ± 139.53 684.40 ± 84.12# 12.76 ± 4.55 44.38 ± 10.11#* 11.20 ± 2.48 4.55 ± 1.10# 对照组（n = 25） 1134.09 ± 132.21 674.96 ± 80.74# 12.24 ± 4.47 35.17 ± 8.24# 11.52 ± 2.46 4.64 ± 1.23# t 0.205 0.405 0.408 3.531 0.458 0.273 P 0.839 0.687 0.685 0.001 0.649 0.786 与同组术前比较，#P < 0.05；与对照组比较，*P < 0.05。
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表 5 2组术前及术后6个月营养状况比较（
$\bar x \pm s$ ）Table 5. Comparison of nutritional status before and 6 months after operation between the two groups （
$\bar x \pm s$ ）组别 血红蛋白（g/L） 血浆白蛋白（g/L） 体质量（kg） 术前 术后6个月 术前 术后6个月 术前 术后6个月 观察组（n = 25） 138.46 ± 16.34 112.34 ± 12.41#* 46.07 ± 4.31 41.32 ± 3.74# 65.31 ± 6.58 60.87 ± 6.30# 对照组（n = 25） 139.76 ± 16.82 101.43 ± 10.16# 45.35 ± 4.36 37.13 ± 3.21# 64.87 ± 6.53 57.21 ± 5.47# t 0.277 3.401 0.832 4.251 0.237 2.193 P 0.783 0.001 0.410 < 0.001 0.813 0.033 与同组术前比较，#P < 0.05；与对照组比较，*P < 0.05。
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