Kinami Shinichi, Takahashi Masazumi, Urushihara Takashi, Ikeda Masami, Yoshida Masashi, Uenosono Yoshikazu, Oshio Atsushi, Suzukamo Yoshimi, Terashima Masanori, Kodera Yasuhiro, Nakada Koji
Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan.
Division of Gastroenterological Surgery, Yokohama Municipal Citizen's Hospital, Yokohama 240-8555, Japan.
World J Clin Cases. 2018 Dec 26;6(16):1111-1120. doi: 10.12998/wjcc.v6.i16.1111.
Postgastrectomy syndromes (PGS) after curative gastrectomy for gastric cancer are influenced by not only gastrectomy type but also by background factors. Recently, a nationwide PGS study was performed using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire.
To determine the influence of each background factor on PGS for each gastrectomy type using PGS assessment study (PGSAS) data as an additional analysis.
The data of 2368 patients were obtained from the PGSAS. This included patients undergoing distal gastrectomy (DG) with Billroth I reconstruction, DG with Roux-en-Y reconstruction, total gastrectomy with Roux-en-Y, proximal gastrectomy, pylorus-preserving gastrectomy (PPG), and local resection. Multiple regression analysis was performed to explore the independent effects of each background factor on the main outcome measures (MOMs) of PGSAS-45 for each gastrectomy type. The background factors included postoperative period, age, sex, surgical approach (laparoscopic or open), and the status of the celiac branch of the vagal nerve.
The MOMs of DG and PPG were highly affected by background factors, whereas those of total gastrectomy with Roux-en-Y, proximal gastrectomy, and local resection were not. Worse PGS were found in females, whereas a longer postoperative period alleviated some of the MOMs. For DG and PPG, a laparoscopic approach and preservation of the celiac branch improved several MOMs.
Various background factors affected PGS, and their influence varied with the type of gastrectomy performed. Laparoscopic surgery and celiac branch preservation can improve PGS in patients undergoing DG and PPG.
胃癌根治性胃切除术后的胃切除术后综合征（PGS）不仅受胃切除类型影响，还受背景因素影响。最近，一项全国性的PGS研究使用胃切除术后综合征评估量表-45（PGSAS-45）问卷进行。
以PGS评估研究（PGSAS）数据作为额外分析，确定每种背景因素对每种胃切除类型的PGS的影响。
从PGSAS获得2368例患者的数据。这包括接受毕Ⅰ式重建的远端胃切除术（DG）、Roux-en-Y重建的DG、Roux-en-Y全胃切除术、近端胃切除术、保留幽门胃切除术（PPG）和局部切除术的患者。进行多元回归分析，以探讨每种背景因素对每种胃切除类型的PGSAS-45主要结局指标（MOMs）的独立影响。背景因素包括术后时期、年龄、性别、手术方式（腹腔镜或开放）以及迷走神经腹腔支的状态。
DG和PPG的MOMs受背景因素影响很大，而Roux-en-Y全胃切除术、近端胃切除术和局部切除术的MOMs则不受影响。女性的PGS更差，而术后时间较长可缓解部分MOMs。对于DG和PPG，腹腔镜手术方式和保留腹腔支可改善多个MOMs。
各种背景因素影响PGS，其影响因所进行的胃切除类型而异。腹腔镜手术和保留腹腔支可改善接受DG和PPG患者的PGS。
