Department of Gastroenterological Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Department of Surgery, Yodogawa Christian Hospital, Higashiyodogawa, Osaka, Japan.
PLoS One. 2021 Feb 24;16(2):e0247636. doi: 10.1371/journal.pone.0247636. eCollection 2021.
The optimal reconstruction method after proximal gastrectomy (PG) has been debatable. Recent reports have shown that the double-flap technique (DFT) provides good outcomes in terms of postoperative nutritional status and quality of life. However, no study has compared the clinical outcomes of the DFT with other reconstruction methods. Here, we evaluated and compared the clinical outcomes between the DFT and jejunal interposition (JI) after PG for gastric cancer.
The medical records of 34 consecutive patients who had undergone PG for upper third gastric cancer between January 2011 and October 2016 were reviewed retrospectively. The main factors investigated were surgical outcomes, postoperative nutritional status, symptoms, and endoscopic findings 1 year after surgery.
Thirty-four patients were enrolled (DFT, 14; JI, 20). The operation time was similar between the two techniques (228 and 246 minutes for DFT and JI, respectively, P = 0.377), as were the rates of anastomotic complications (7% and 0% for DFT and JI, respectively, P = 0.412). Body weight loss was significantly lower in the DFT group than in the JI group (-8.1% vs -16.1%, P = 0.001). Total protein and albumin levels were higher in the DFT group than in the JI group (0% vs -2.9%, P = 0.053, and -0.3% vs -6.1%, P = 0.077, respectively). One patient in the DFT group and no patients in the JI group experienced reflux esophagitis (≥ grade B) (P = 0.393). Anastomotic strictures were not observed as postoperative complications in either group.
Surgical outcomes revealed that the DFT was safe and feasible, similar to JI. In terms of controlling postoperative body weight loss, the DFT is a better reconstruction technique than JI after PG.
近端胃切除术后（PG）的最佳重建方法一直存在争议。最近的报告显示，双瓣技术（DFT）在术后营养状况和生活质量方面提供了良好的结果。然而，尚无研究比较 DFT 与其他重建方法的临床结果。在这里，我们评估并比较了 DFT 与 PG 后用于胃癌的空肠间置术（JI）的临床结果。
回顾性分析 2011 年 1 月至 2016 年 10 月期间连续 34 例接受 PG 治疗的上三分之一胃癌患者的病历。主要调查因素为手术结果、术后营养状况、症状和术后 1 年的内镜发现。
共纳入 34 例患者（DFT 组 14 例，JI 组 20 例）。两种技术的手术时间相似（DFT 组和 JI 组分别为 228 分钟和 246 分钟，P = 0.377），吻合口并发症发生率也相似（DFT 组为 7%，JI 组为 0%，P = 0.412）。DFT 组的体重减轻明显低于 JI 组（-8.1% vs.-16.1%，P = 0.001）。DFT 组的总蛋白和白蛋白水平均高于 JI 组（0% vs.-2.9%，P = 0.053，-0.3% vs.-6.1%，P = 0.077）。DFT 组有 1 例患者发生反流性食管炎（≥B 级），而 JI 组无患者发生（P = 0.393）。两组均未观察到吻合口狭窄等术后并发症。
手术结果表明，DFT 是一种安全可行的方法，与 JI 相似。在控制术后体重减轻方面，DFT 是 PG 后优于 JI 的重建技术。
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