摘要
目的分析比较腹腔镜全胃切除术食管空肠经辅助切口圆形吻合与腔内吻合的安全性和有效性。方法采用回顾性队列研究方法,收集2018年10月至2021年6月期间,在南方医科大学南方医院普通外科行腹腔镜全胃切除、D2淋巴结清扫、并完成食管空肠Roux-en-Y吻合术、具备术后6个月完整随访资料的261例胃癌患者的临床资料。根据患者食管空肠吻合方式不同进行分组,采用经辅助切口圆形吻合139例(辅助切口圆吻组),腔内吻合122例(腔内吻合组),腔内吻合组中OrVil^(TM)吻合43例(OrVil^(TM)吻合组),Overlap吻合79例(Overlap吻合组)。与辅助切口圆吻组的基线资料比较,腔内吻合组患者的体质指数偏大,肿瘤直径偏小,肿瘤T分期和M分期偏早,差异均有统计学意义(均P<0.05);与Overlap吻合组基线资料比较,OrVil^(TM)吻合组术前合并胃癌所致梗阻比例以及侵犯食管的比例均较高,T分期较晚,差异均有统计学意义(均P<0.05);两组其他基线资料的比较,差异均无统计学意义(均P>0.05)。主要观察指标为比较辅助切口圆吻组与腔内吻合组以及OrVil^(TM)吻合与Overlap吻合两个亚组的术后6个月内并发症发生情况;次要观察指标为上述各组手术情况、术中并发症发生情况以及术后恢复情况的比较。符合正态分布的连续变量采用±s表示,两组间比较采用t检验;非正态分布的连续变量用M(IQR)表示,两组间比较采用Mann-Whiney U检验;分类变量用例(%)表示,组间比较采用χ^(2)检验、连续校正χ^(2)检验或Fisher精确检验。结果辅助切口圆吻组与腔内吻合组手术情况比较,腔内吻合组手术切口更小[5.0(1.0)cm比8.0(1.0)cm,Z=-10.931,P=0.001]、联合脏器切除比例更低[0.8%(1/122)比7.9%(11/139),χ^(2)=7.454,P=0.006]、R0切除率更高[94.3%(115/122)比84.9(118/139),χ^(2)=5.957,P=0.015],差异均有统计学意义(均P<0.05);辅助切口圆吻组和腔内吻合组术中并发症发生率分别�
Objective To compare the safety and effectiveness of esophagojejunostomy(EJS)through extracorporeal and intracorporeal methods after laparoscopic total gastrectomy(LTG).Methods A retrospective cohort study was carried out.Clinicopathological data of 261 gastric cancer patients who underwent LTG,D2 lymphadenectomy,and Roux-en-Y EJS with complete postoperative 6-month follow-up data at the General Surgery Department of Nanfang Hospital from October 2018 to June 2021 were collected.Among these 261 patients,139 underwent EJS with a circular stapler via mini-laparotomy(extracorporeal group),while 122 underwent intracorporeal EJS(intracorporeal group),including 43 with OrVil^(TM) anastomosis(OrVil^(TM) subgroup)and 79 with Overlap anastomosis(Overlap subgroup).Compared with the extracorporeal group,the intracorporeal group had higher body mass index,smaller tumor size,earlier T stage and M stage(all P<0.05).Compared with the Overlap subgroup,the OrvilTM subgroup had higher proportions of upper gastrointestinal obstruction and esophagus involvement,and more advanced T stage(all P<0.05).No other significant differences in the baseline data were found(all P>0.05).The primary outcome was complications at postoperative 6-month.The secondary outcomes were operative status,intraoperative complication and postoperative recovery.Continuous variables with a skewed distribution are expressed as the median(interquartile range),and were compared using Mann-Whitney U test.Categorical variables are expressed as the number and percentage and were compared with the Pearson chi-square,continuity correction or Fisher's exact test.Results Compared with the extracorporeal group,the intracorporeal group had smaller incision[5.0(1.0)cm vs.8.0(1.0)cm,Z=-10.931,P=0.001],lower rate of combined organ resection[0.8%(1/122)vs.7.9%(11/139),χ^(2)=7.454,P=0.006]and higher rate of R0 resection[94.3%(115/122)vs.84.9(118/139),χ^(2)=5.957,P=0.015].The morbidity of intraoperative complication in the extracorporeal group and intracorporeal group was 2.9%
作者
陈新华
胡彦锋
林填
赵明利
陈韬
陈豪
麦锦胜
梁延锐
刘浩
赵丽瑛
李国新
余江
Chen Xinhua;Hu Yanfeng;Lin Tian;Zhao Mingli;Chen Tao;Chen Hao;Mai Jinsheng;Liang Yanrui;Liu Hao;Zhao Lying;Li Guoxin;Yu Jiang(Department of General Surgery&Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;The Second School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2022年第5期421-432,共12页
Chinese Journal of Gastrointestinal Surgery
基金
广东省胃肠肿瘤精准微创诊疗重点实验室(2020B121201004)
南方医科大学南方医院临床研究专项(2021CR001)
2021年广东省科技创新战略专项资金重点项目(pdjh2022a0092、pdjh2022a0093)
2021年大学生创新创业训练项目(202112121019)。
