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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 95 -99. doi: 10.3877/cma.j.issn.1674-0793.2021.02.004

所属专题： 文献；

论著

腹腔镜下双通道重建治疗近端胃癌的近期临床结局：倾向性评分匹配分析
姬彦彬1, 崔建明1, 刘建1, 郑惟青1, 任俭1,†()   
  1. 1. 245000　黄山市人民医院胃肠外科
  • 收稿日期:2020-11-30 出版日期:2021-04-01
  • 通信作者: 任俭

Short term outcomes of laparoscopic double-channel reconstruction for proximal gastric cancer: propensity score matching analysis

Yanbin Ji1, Jianming Cui1, Jian Liu1, Weiqing Zheng1, Jian Ren1,†()   

  1. 1. Department of Gastrointestinal Surgery, Huangshan People's Hospital, Huangshan 245000, China
  • Received:2020-11-30 Published:2021-04-01
  • Corresponding author: Jian Ren
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姬彦彬, 崔建明, 刘建, 郑惟青, 任俭. 腹腔镜下双通道重建治疗近端胃癌的近期临床结局：倾向性评分匹配分析[J]. 中华普通外科学文献(电子版), 2021, 15(02): 95-99.

Yanbin Ji, Jianming Cui, Jian Liu, Weiqing Zheng, Jian Ren. Short term outcomes of laparoscopic double-channel reconstruction for proximal gastric cancer: propensity score matching analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(02): 95-99.

目的

通过对比分析腹腔镜近端胃切除双通道吻合重建（PG）治疗胃上部肿瘤的近期临床结局，探究双通道吻合在近端胃癌根治术中的应用效果。

方法

采用回顾性队列研究方法。收集黄山市人民医院2017年5月至2020年4月择期行腹腔镜下胃上部肿瘤切除术的84例患者临床数据，通过倾向性匹配分析法，比较PG和腹腔镜全胃切除Roux-en-Y吻合术（TG）治疗胃上部肿瘤的近期临床结局。

结果

84例患者中PG 19例，TG 65例，按11倾向性匹配分为PG组和TG组，各19例，两组数据分布均匀。与TG组比较，PG组并未显著增加术后并发症、住院时间及住院费用，但术后首次排气时间明显早于TG组，术后3个月时白蛋白水平和体质量恢复更优（t=2.660，P=0.012；Z=-2.669，P=0.008）。PG组并未显著增加术后出现严重并发症的风险（P=0.486），相反可能潜在减少术后胃肠道反应出现。

结论

相较于TG，PG治疗胃上部肿瘤在近期临床结局方面是安全可靠的，并有助于患者的营养状况的恢复。

关键词: 胃肿瘤, 腹腔镜, 胃肠吻合术, 双通道消化道重建
Objective

To explore the application value of proximal gastric cancer through the short-term clinical outcomes of laparoscopic proximal gastrectomy with double-channel anastomosis (PG) in the treatment of upper gastric cancer.

Methods

A retrospective cohort study was performed. Clinical data of 84 patients who underwent laparoscopic upper gastric tumor resection in Huangshan People’s Hospital from May 2017 to April 2020 were retrospectively collected. Propensity matching analysis was used to compare the short clinical outcomes of PG and laparoscopic total gastrectomy with Roux-en-Y anastomosis (TG) for upper gastric tumors.

Results

There were 19 cases of PG and 65 cases of TG. After 11 propensity matching, they were divided into group PG and group TG, with 19 patients in each group. The data of the two groups were evenly distributed. Compared with group TG, group PG had no significant increase in postoperative complications, length of hospital stay, and hospitalization expenses, but the first exhaust time was significantly earlier, and the albumin level and body weight recovery were better at3 months after operation (t=2.660, P=0.012; Z=-2.669, P=0.008). Group PG did not significantly increase the risk of serious postoperative complications (P=0.486), whereas it might potentially reduce postoperative gastrointestinal reactions.

Conclusion

Compared with TG, PG is safe and feasible in the short term clinical outcome, and helps to restore the patients’ nutritional status.

Key words: Stomach neoplasms, Laparoscopes, Gastroenterostomy, Double-channel anastomosis
图1 腹腔镜近端胃切除双通道吻合术示意图　红色箭头模拟食物通过双通道路径
表1 不同手术和消化道重建方式的胃上部肿瘤患者倾向性评分匹配前后基线资料(例)
变量 倾向性评分匹配前 倾向性评分匹配后
PG组 TG组 χ2值 P值 PG组 TG组 χ2值 P值
例数 19 65     19 19    
性别                
  　男 17 47 - 0.219 17 17 - 1.000
  　女 2 18     2 2    
年龄(岁)                
  　≥65 11 39 0.027 0.869 10 10 0.106 1.000
  　<65 8 26     9 9    
存在营养不良风险                
  　是 6 32 1.849 0.174 6 6 0.000 1.000
  　否 13 33     13 13    
ASA分级                
  　Ⅰ/Ⅱ 18 62 - 1.000 17 18 - 1.000
  　Ⅲ 1 3     2 1    
组织分化程度                
  　高/中 8 17 1.790 0.181 8 8 0.000 1.000
  　低 11 48     11 11    
低蛋白血症                
  　有 5 17 0.000 0.989 1 3 - 0.604
  　无 14 48     18 16    
Charlson合并症指数(分)                
  　0/1 17 60 - 0.654 17 16 - 1.000
  　≥2 2 5     2 3    
术前贫血                
  　有 7 27 0.135 0.714 7 7 0.000 1.000
  　无 12 38     12 13    
T分期                
  　1/2 8 14 3.217 0.073 8 6 0.452 0.501
  　3/4 11 51     11 13    
N分期                
  　0/1 14 22 9.528 0.002a 14 12 0.487 0.485
  　2/3 5 43     5 7    
表2 不同手术和消化道重建方式对胃上部肿瘤患者近期临床结局的影响
组别 清扫淋巴结数目(枚)a 术前白蛋白(g/L)b 术后首次排气时间(d)a 术后并发症c[例(%)] 术后住院时间(d)a 出院时白蛋白(g/L)b 出院时体重下降(kg)a 总住院费用(元)a 术后3个月白蛋白(g/L)b 术后3个月体质量下降(kg)a
PG组 23(19, 24) 37.52±4.37 2(2, 3) 5(26.3) 14(11, 16) 33.44±3.37 3(1, 4.5) 46 746.59(41 932.52~49 572.54) 40.10±4.94 4(2, 5)
TG组 25(18, 31) 37.37±3.83 3(3, 4) 5(26.3) 14(12, 15) 33.5±3.07 3(2, 5) 43 419.18(39 247.17, 52 074.17) 35.89±4.81 9(4, 10.5)
统计值 -1.043 0.111 -2.342 0 -0.089 -0.055 -1.001 -0.686 2.660 -2.669
P值 0.311 0.913 0.019 1.000 0.929 0.956 0.317 0.493 0.012 0.008
表3 不同手术和消化道重建方式治疗胃上部肿瘤患者术后并发症情况(例)
组别 例数 胃肠道反应 术后并发症 严重并发症
吻合口漏/狭窄/胃瘫 吻合口/腹腔出血 低蛋白血症 肺部/腹腔感染 心血管疾病
PG组 19 1 0 3 1 1 1 0
TG组 19 6 0 2 3 2 0 2
P值   0.090 - 1.000 0.604 1.000 1.000 0.486
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