Wu Chu-Ying, Huang Qiao-Zhen, Ye Kai
Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Front Oncol. 2024 Sep 2;14:1414120. doi: 10.3389/fonc.2024.1414120. eCollection 2024.
This study aimed to explore the short-term clinical efficacy of modified Kamikawa anastomosis and double tract anastomosis after laparoscopic proximal gastrectomy.
A retrospective analysis was carried out by collecting the clinical and pathological data of 42 patients who underwent laparoscopic proximal gastrectomy after admission in our centre from May 2020 to October 2022. Among the 42 enrolled patients, 22 underwent modified Kamikawa anastomosis (modified Kamikawa group), and the other 20 underwent double tract anastomosis (double tract group). Outcome measures included intraoperative condition, postoperative recovery, postoperative quality of life, postoperative nutritional status and gastroesophageal reflux. The patients were followed up using outpatient examination and telephone interviews to identify their nutritional status, reflux esophagitis and anastomotic status.
(1) Intraoperative condition: Compared with the double tract group, the modified Kamikawa group had significantly prolonged time for operation and digestive tract reconstruction. However, no statistically significant difference in intraoperative blood loss was found between the two groups. (2) Postoperative recovery: Compared with the double tract group, the modified Kamikawa group had a significantly shorter time for the first postoperative intake of fluids, drainage tube placement and postoperative hospital stay. No statistically significant difference in the time to first postoperative anal exhaust and postoperative complications was found between the two groups. (3) Postoperative quality of life: Compared with the double tract group, the modified Kamikawa group showed better quality of life at 12 months after surgery. (4) Postoperative nutritional status and gastroesophageal reflux: No statistically significant difference in hemoglobin, total serum albumin, albumin, body mass index, MUST score, PG-SGA score, grading of reflux esophagitis using the Los Angeles classification system and GERD score was found between the two groups at 6 and 12 months after surgery. All patients did not experience anastomotic stenosis and tumour recurrence or metastasis.
Modified Kamikawa anastomosis is a safe and feasible treatment in laparoscopic proximal gastrectomy, which can ensure good postoperative anti-reflux effect and nutritional status. It has the advantage of better postoperative recorvery and quality of life compared with double tract anastomosis.
本研究旨在探讨改良镰川吻合术与双通道吻合术在腹腔镜近端胃切除术后的短期临床疗效。
回顾性分析2020年5月至2022年10月期间在本中心入院后接受腹腔镜近端胃切除术的42例患者的临床和病理资料。在42例入组患者中，22例行改良镰川吻合术（改良镰川组），另外20例行双通道吻合术（双通道组）。观察指标包括术中情况、术后恢复、术后生活质量、术后营养状况和胃食管反流。通过门诊检查和电话访谈对患者进行随访，以确定其营养状况、反流性食管炎和吻合口状况。
（1）术中情况：与双通道组相比，改良镰川组的手术时间和消化道重建时间明显延长。然而，两组术中出血量差异无统计学意义。（2）术后恢复：与双通道组相比，改良镰川组术后首次进食流质时间、引流管留置时间和术后住院时间明显缩短。两组术后首次肛门排气时间和术后并发症差异无统计学意义。（3）术后生活质量：与双通道组相比，改良镰川组术后12个月生活质量更好。（4）术后营养状况和胃食管反流：术后6个月和12个月时，两组血红蛋白、血清总蛋白、白蛋白、体重指数、营养不良通用筛查工具（MUST）评分、患者主观全面评定法（PG-SGA）评分、采用洛杉矶分类系统的反流性食管炎分级和胃食管反流病（GERD）评分差异无统计学意义。所有患者均未出现吻合口狭窄及肿瘤复发或转移。
改良镰川吻合术在腹腔镜近端胃切除术中是一种安全可行的术式，可确保良好的术后抗反流效果和营养状况。与双通道吻合术相比，其术后恢复和生活质量更佳。
