腹腔镜胃部分分隔式胃空肠吻合术治疗进展期胃癌致胃出口梗阻患者的疗效
Effectiveness of laparoscopic stomach-partitioning gastrojejunostomy for patients with gastric outlet obstruction caused by advanced gastric cancer.
作者信息
Tanaka Tsuyoshi, Suda Koichi, Satoh Seiji, Kawamura Yuichiro, Inaba Kazuki, Ishida Yoshinori, Uyama Ichiro
机构信息
Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Department of Surgery, Himeji Medical Center, Himeji, Japan.
出版信息
Surg Endosc. 2017 Jan;31(1):359-367. doi: 10.1007/s00464-016-4980-0. Epub 2016 Jun 10.
BACKGROUND
Distal advanced gastric cancer (AGC) occasionally causes gastric outlet obstruction (GOO). We developed a laparoscopic stomach-partitioning gastrojejunostomy (LSPGJ) to restore the ability of food intake.
METHODS
This was a retrospective study performed at a single institution. Of consecutive 78 patients with GOO caused by AGC between 2006 and 2012, 43 patients who underwent LSPGJ were enrolled. The procedure was performed in an antiperistaltic Billroth II fashion, and the afferent loop was elevated and fixed along the staple line of the proximal partitioned stomach. Then, patients for whom R0 resection was planned received chemotherapy prior to laparoscopic gastrectomy. The primary end point was food intake at the time of discharge, which was evaluated using the GOO scoring system (GOOSS). Short- and long-term outcomes were assessed as secondary end points. Overall survival was estimated and compared between the groups who received neoadjuvant chemotherapy followed by surgery (NAC group), definitive chemotherapy followed by curative resection (Conversion group), and best supportive care (BSC group).
RESULTS
The median operative time was 92 min, blood loss did not exceed 30 g in any patient, and postoperative complications (Clavien-Dindo grade ≥2) were only seen in four patients (9.3 %). The median time to food intake was 3 days, and GOOSS scores were significantly improved in 41 patients (95.3 %). Chemotherapy was administered to 38 patients (88.4 %), of whom 11 later underwent radical resection, and 4 of 11 patients underwent conversion surgery following definitive chemotherapy. Median survival times were significantly superior in the NAC (n = 7; 46.8 months) and Conversion (n = 4; 35.9 months) groups than in the BSC group (n = 26; 12.2 months); however, the difference was not significant between the Conversion and NAC groups.
CONCLUSIONS
LSPGJ is a feasible and safe minimally invasive induction surgery for patients with GOO from surgical and oncological perspectives.
背景
晚期远端胃癌（AGC）偶尔会导致胃出口梗阻（GOO）。我们研发了一种腹腔镜胃分隔空肠吻合术（LSPGJ）来恢复患者的进食能力。
方法
这是一项在单一机构进行的回顾性研究。在2006年至2012年间连续纳入78例由AGC导致GOO的患者，其中43例行LSPGJ的患者被纳入研究。手术采用逆蠕动毕Ⅱ式进行，输入袢沿近端分隔胃的吻合线提起并固定。然后，计划行R0切除的患者在腹腔镜胃切除术前接受化疗。主要终点是出院时的进食情况，采用胃出口梗阻评分系统（GOOSS）进行评估。短期和长期结局作为次要终点进行评估。对接受新辅助化疗后手术的患者组（NAC组）、根治性化疗后行根治性切除的患者组（转化组）和最佳支持治疗组（BSC组）的总生存期进行估计和比较。
结果
中位手术时间为92分钟，所有患者失血量均未超过30克，术后并发症（Clavien-Dindo分级≥2级）仅见于4例患者（9.3%）。进食的中位时间为3天，41例患者（95.3%）的GOOSS评分显著改善。38例患者（88.4%）接受了化疗，其中11例后来接受了根治性切除，11例患者中有4例在根治性化疗后接受了转化手术。NAC组（n = 7；46.8个月）和转化组（n = 4；35.9个月）的中位生存时间显著优于BSC组（n = 26；12.2个月）；然而，转化组和NAC组之间的差异不显著。
结论
从外科和肿瘤学角度来看，LSPGJ对于GOO患者是一种可行且安全的微创诱导手术。
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