摘要
目的探讨腹腔镜全胃切除术中食管-空肠手工吻合与Roux-en-Y吻合的近期疗效。方法采用倾向评分匹配及回顾性队列研究方法。收集2014年10月至2021年7月上海交通大学医学院附属仁济医院收治的159例行腹腔镜全胃切除术胃癌患者的临床病理资料;男107例,女52例;年龄为63(28~79)岁。159例患者中,71例行完全腹腔镜全胃切除术中消化道重建采用食管-空肠手工吻合,设为完全腹腔镜组;88例行腹腔镜辅助全胃切除术中消化道重建采用传统Roux-en-Y吻合,设为腹腔镜辅助组。观察指标:(1)倾向评分匹配情况及匹配后两组患者一般资料比较。(2)术中和术后情况。(3)围手术期并发症情况。倾向评分匹配按1∶1最近邻匹配法匹配。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示,组间比较采用Mann-Whitney U检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验或Fisher确切概率法。等级资料比较采用秩和检验。结果(1)倾向评分匹配情况及匹配后两组患者一般资料比较:159例患者中,112例配对成功,完全腹腔镜组和腹腔镜辅助组各56例。倾向评分匹配前完全腹腔镜组患者年龄,肿瘤位置(贲门部、胃体部)分别为61(30~76)岁,26、45例;腹腔镜辅助组患者上述指标分别为65(28~79)岁,50、38例;两组患者上述指标比较,差异均有统计学意义(Z=-2.89,χ^(2)=6.43,P<0.05)。倾向评分匹配后完全腹腔镜组患者性别(男、女),年龄,体质量指数,美国麻醉医师协会分级(Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级),肿瘤长径,肿瘤位置(贲门部、胃体部),TNM分期(Ⅰ期、Ⅱ期、Ⅲ期)分别为40、16例,(62±9)岁,(22.7±2.8)kg/m^(2),22、26、7、1例,3.5(0.6~17.0)cm,24、32例,22、9、25例;腹腔镜辅助组患者上述指标分别为38、18例,(62±10)岁,(22.7±3.2)kg/m^(2),19、32、5、0例,4.0(0.6~15.0)cm,23、33例,21、7、28例;两组患者上述�
Objective To investigate the short-term efficacy of laparoscopic total gastrec-tomy with hand-sewn esophagojejunostomy versus Roux-en-Y anastomosis.Methods The propen-sity score matching and retrospective cohort study was conducted.The clinicopathological data of 159 patients who underwent laparoscopic total gastrectomy in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from October 2014 to July 2021 were collected.There were 107 males and 52 females,aged 63(range,28‒79)years.Of 159 patients,71 cases undergoing totally laparoscopic total gastrectomy with hand-sewn esophagojejunostomy were allocated into totally laparoscopic group and 88 cases undergoing laparoscopic-assisted total gastrectomy with Roux-en-Y anastomosis were allocated into laparoscopic-assisted group,respectively.Observation indicators:(1)propensity score matching and comparison of general data of patients between the two groups after matching;(2)intraoperative and postoperative conditions;(3)perioperative complications.Propensity score matching was done by the 1:1 nearest neighbor matching method.Measurement data with normal distribution were expressed as Mean±SD,and t test was used for comparison between groups.Measurement data with skewed distribution were expressed as M(range),and the Mann-Whitney U test was used for comparison between groups.Count data were expressed as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test or Fisher's exact probability method.The rank sum test was used for comparison of ordinal data.Results(1)Propensity score matching and comparison of general data of patients between the two groups after matching.Of 159 patients,112 cases were successfully matched,including 56 cases in the totally laparoscopic group and 56 cases in the laparoscopic-assisted group.Before propensity score matching,age,cases with tumor located in cardia or gastric body in the totally laparoscopic group were 61(range,30‒76)years,26,45,respectively.The above indicato
作者
马欣俐
王亦璜
顾佳毅
杨琳希
徐佳
张子臻
曹晖
邱江锋
Ma Xinli;Wang Yihuang;Gu Jiayi;Yang Linxi;Xu Jia;Zhang Zizhen;Cao Hui;Qiu Jiangfeng(Department of Gastrointestinal Surgery,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;The First Department of Surgery,Fuding Hospital,Fujian University of Traditional Chinese Medicine,Ningde 355200,Fujian Province,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2022年第5期628-634,共7页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(82173215)。
关键词
胃肿瘤
外科手术
治疗结果
完全腹腔镜全胃切除术
食管-空肠手工缝合
腹腔镜辅助全胃切除术
倾向评分匹配
疗效
Stomach neoplasms
Surgical procedures,operative
Treatment outcomes
Totally laparoscopic total gastrectomy
Hand-sewn esophagojejunostomy
Laparoscopic-assisted total gastrectomy
Propensity score matching
Efficacy
