Wu Chu-Ying, Zhu Yue-Jia, Ye Kai
Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.
BMC Gastroenterol. 2025 Mar 3;25(1):129. doi: 10.1186/s12876-025-03724-2.
To investigate the short-term efficacy of laparoscopic proximal gastrectomy (LPG) with modified side overlap anastomosis in comparison with laparoscopic total gastrectomy (LTG) with Roux-en-Y anastomosis.
A retrospective cohort study was conducted. The clinicopathological data of 262 patients who underwent LPG or LTG for upper gastric adenocarcinoma from January 2016 to December 2022 were collected. Among 262 patients, 20 who underwent LPG with a modified side overlap anastomosis were assigned to the side overlap group, and 242 who underwent LTG with Roux-en-Y anastomosis were assigned to the Roux-en-Y group. After 1:1 matching of patients in the side overlap and Roux-en-Y groups via the propensity score matching method, 15 patients were included in this study. The outcome measures included the following: (1) intraoperative conditions, (2) postoperative recovery and (3) follow-up information.
(1) Intraoperative conditions. Compared with the Roux-en-Y group, the side overlap group had a longer digestive tract reconstruction time. No significant difference was observed in the total operation time or amount of intraoperative blood loss. (2) Postoperative recovery. No statistically significant difference was detected between the side overlap and Roux-en-Y groups in terms of indicators, such as first anal exhaust time, first postoperative liquid intake time, postoperative hospitalization time and postoperative complications. (3) Follow-up information. The body mass index, haemoglobin, albumin, and Nutritional Risk Screening 2002 scores of the side overlap group were better than those of the Roux-en-Y group at 12 and 18 months after surgery. No significant difference was observed in the gastroesophageal reflux disease scale score or occurrence of ≥ Grade B reflux oesophagitis at 12 and 18 months after surgery between the side overlap and Roux-en-Y groups.
LPG with a modified side overlap anastomosis is safe and feasible for the treatment of upper gastric adenocarcinoma and can achieve good antireflux effects. In addition, compared with traditional LTG, the postoperative nutritional status after LTG is better.
探讨改良侧侧吻合的腹腔镜近端胃切除术（LPG）与Roux-en-Y吻合的腹腔镜全胃切除术（LTG）的短期疗效。
进行一项回顾性队列研究。收集2016年1月至2022年12月期间因胃上部腺癌接受LPG或LTG治疗的262例患者的临床病理数据。在262例患者中，20例行改良侧侧吻合的LPG患者被分配到侧侧吻合组，242例行Roux-en-Y吻合的LTG患者被分配到Roux-en-Y组。通过倾向评分匹配法对侧侧吻合组和Roux-en-Y组患者进行1:1匹配后，本研究纳入15例患者。观察指标包括：（1）术中情况，（2）术后恢复情况，（3）随访信息。
（1）术中情况。与Roux-en-Y组相比，侧侧吻合组消化道重建时间更长。总手术时间和术中出血量差异无统计学意义。（2）术后恢复。侧侧吻合组与Roux-en-Y组在首次肛门排气时间、术后首次进流食时间、术后住院时间及术后并发症等指标方面差异无统计学意义。（3）随访信息。术后12个月和18个月时，侧侧吻合组的体重指数、血红蛋白、白蛋白及营养风险筛查2002评分均优于Roux-en-Y组。术后12个月和18个月时，侧侧吻合组与Roux-en-Y组在胃食管反流病量表评分或≥B级反流性食管炎发生率方面差异无统计学意义。
改良侧侧吻合的LPG治疗胃上部腺癌安全可行，可取得良好的抗反流效果。此外，与传统LTG相比，LPG术后营养状况更佳。
