Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Yangzhou, People's Republic of China.
Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China.
BMC Surg. 2023 Oct 12;23(1):309. doi: 10.1186/s12893-023-02219-9.
There is no consensus on the optimal reconstruction technique after proximal gastrectomy. The purpose of this study was to retrospectively compare the surgical outcomes among esophagogastrostomy (EG) anastomosis, gastric tube (GT) reconstruction and double-tract (DT) reconstruction in patients who underwent laparoscopic proximal gastrectomy (LPG) to clarify the superior reconstruction method.
This study enrolled 164 patients who underwent LPG at the Northern Jiangsu People's Hospital in Jiangsu between January 2017 to January 2022 (EG: 51 patients; GT: 77 patients; DT: 36 patients). We compared the clinical and pathological characteristics, surgical features, postoperative complications, nutritional status, and quality of life (QOL) among the above three groups.
Mean operative time was longer with the DT group than the remaining two groups (p = 0.001). With regard to postoperative complications, considerable differences in the postoperative reflux symptoms (p = 0.042) and reflux esophagitis (p = 0.040) among the three groups were found. For the nutritional status, total protein, hemoglobin and albumin reduction rates in the GT group were significantly higher than the other two groups at 12 months postoperatively. In the PGSAS-45, three assessment items were better in the DT group significantly compared with the esophageal reflux subscale (p = 0.047, Cohen's d = 0.44), dissatisfaction at the meal (p = 0.009, Cohen's d = 0.58), and dissatisfaction for daily life subscale (p = 0.012, Cohen's d = 0.56).
DT after LPG is a valuable reconstruction technique with satisfactory surgical outcomes, especially regarding reduced reflux symptoms, improving the postoperative nutritional status and QOL.
近端胃切除术后的最佳重建技术尚无共识。本研究旨在回顾性比较腹腔镜近端胃切除术后行食管胃吻合术（EG）吻合、胃管（GT）重建和双管（DT）重建的手术结果，以明确更优的重建方法。
本研究纳入了 2017 年 1 月至 2022 年 1 月期间在江苏省苏北人民医院接受腹腔镜近端胃切除术的 164 例患者（EG 组 51 例；GT 组 77 例；DT 组 36 例）。我们比较了三组患者的临床和病理特征、手术特点、术后并发症、营养状况和生活质量（QOL）。
DT 组的平均手术时间长于其余两组（p=0.001）。在术后反流症状（p=0.042）和反流性食管炎（p=0.040）方面，三组之间存在明显差异。在营养状况方面，GT 组术后 12 个月的总蛋白、血红蛋白和白蛋白降低率明显高于其余两组。在 PGSAS-45 中，DT 组在三个评估项目上明显优于食管反流亚量表（p=0.047，Cohen's d=0.44）、对进餐的不满（p=0.009，Cohen's d=0.58）和对日常生活的不满亚量表（p=0.012，Cohen's d=0.56）。
LPG 后的 DT 是一种有价值的重建技术，具有满意的手术结果，尤其是在减轻反流症状、改善术后营养状况和 QOL 方面。
