切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (03) : 159 -165. doi: 10.3877/cma.j.issn.1674-6899.2020.03.008

所属专题: 文献

论著

腹腔镜辅助下三种消化道重建方式在食管胃结合部腺癌中的临床疗效分析
李东亮1, 周家杰2, 杜瑞2, 王峰2, 佟贵繁2, 丁旭1, 张琪1, 汪刘华3, 王伟3, 汤东3, 王道荣3,()   
  1. 1. 225000 扬州大学医学院
    2. 116044 大连医科大学研究生院
    3. 225000 扬州大学附属苏北医院胃肠中心 扬州大学-扬州市普通外科研究所 胃肠外科
  • 收稿日期:2019-12-24 出版日期:2020-06-30
  • 通信作者: 王道荣
  • 基金资助:
    江苏省第五期"333工程"高层次人才培养专项(BRA2017153)

Analysis of clinical efficacy of three laparoscopic assisted digestive tract reconstruction methods in esophagogastric junction adenocarcinoma

Dongliang Li1, Jiajie Zhou2, Rui Du2, Feng Wang2, Guifan Tong2, Xu Ding1, Qi Zhang1, Liuhua Wang3, Wei Wang3, Dong Tang3, Daorong Wang3,()   

  1. 1. School of Medicine, Yangzhou University, Yangzhou 225000, China
    2. Dalian Medical University, Dalian 116044, China
    3. Department of General Surgery, General Surgery Institute of Yangzhou, Subei People′s Hospital, Clinical Medical College, Yangzhou University, Yangzhou 225000, China
  • Received:2019-12-24 Published:2020-06-30
  • Corresponding author: Daorong Wang
  • About author:
    Corresponding author: Wang Daorong, Email:
引用本文:

李东亮, 周家杰, 杜瑞, 王峰, 佟贵繁, 丁旭, 张琪, 汪刘华, 王伟, 汤东, 王道荣. 腹腔镜辅助下三种消化道重建方式在食管胃结合部腺癌中的临床疗效分析[J/OL]. 中华腔镜外科杂志(电子版), 2020, 13(03): 159-165.

Dongliang Li, Jiajie Zhou, Rui Du, Feng Wang, Guifan Tong, Xu Ding, Qi Zhang, Liuhua Wang, Wei Wang, Dong Tang, Daorong Wang. Analysis of clinical efficacy of three laparoscopic assisted digestive tract reconstruction methods in esophagogastric junction adenocarcinoma[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(03): 159-165.

目的

研究腹腔镜辅助下近端胃切除3种不同消化道重建方式治疗SiewertⅡ型和Siewert Ⅲ型食管胃结合部腺癌(adenocarcinoma of the esophagogastfic junction,AEG)临床疗效。

方法

回顾性分析2016年1月至2018年12月江苏省苏北人民医院收治的93例Siewert Ⅱ型和Siewert Ⅲ型AEG患者资料。根据消化道重建方式不同分为3组,其中31例行食管残胃吻合术(A组)、33例行双通道空肠间置术(B组)、29例行单通道空肠间置术(C组)。采用SPSS 19.0软件进行数据分析。围手术期指标以均数±标准差表示,3组间的计量资料比较采用单因素方差分析,组间两两比较采用t检验,术后并发症发生率等采用χ2检验。P<0.05为差异有统计学意义。

结果

3组患者均顺利完成手术,无围手术期死亡病例。B、C组的手术时间长于A组(P<0.05);术后短期营养状况(血清总蛋白、血红蛋白、血清白蛋白)比较,B、C组均优于A组(P<0.05);3组患者的术后反流性食管炎(reflux esophagitis,RE)发生率分别为35.5%、3.0%、0.0%,差异有统计学意义(P<0.05)。

结论

腹腔镜辅助下近端胃切除的AEG患者行空肠间置术(双通道、单通道吻合)较传统食管残胃吻合术具有更好的术后短期营养状况及较少的术后并发症,尤其在RE方面,空肠间置术具有明显优势,是AEG行近端胃切除患者理想消化道重建方式。

Objective

To study the clinical efficacy of laparoscopic-assisted proximal gastrectomy for three different digestive tract reconstruction methods in the treatment of Siewert Ⅱ and Siewert Ⅲ esophagogastric junction adenocarcinoma (AEG).

Methods

A retrospective analysis of the data of 93 Siewert type Ⅱ and Siewert type Ⅲ AEG patients admitted to the Subei People’s Hospital of Jiangsu Province from Jan. 2016 to Dec. 2018. Divided into three groups according to different ways of digestive tract reconstruction. Among them, 31 esophagogastrostomy (group A), 33 double tract reconstruction (group B)and 29 single-canal jejunum interposition (group C). Data analysis was performed using SPSS 19.0 software. The perioperative indicators were showed by (±s). The measurement data comparison between the three groups was analyzed by single factor analysis of variance. The pairwise comparison between groups was performed by t test. The incidence of postoperative complications was measured by χ2 test. P<0.05 was considered statistically significant.

Results

The three groups of patients successfully completed the operation without perioperative deaths. The operation time of group B and C was longer than that of group A (P<0.05). Compared with postoperative short-term nutritional status (total serum protein, serum albumin, hemoglobin), group B and C were better than group A (P<0.05). The incidences of reflux esophagitis(RE) were 35.5%, 3.0%, and 0.0%, respectively, and the differences were statistically significant (P<0.05).

Conclusions

Laparoscopic-assisted proximal gastrectomy in patients with AEG undergoing jejunal interposition (double tract reconstruction, single-canal jejunum interposition) has better short-term postoperative nutritional status and fewer postoperative complications than traditional esophagogastrostomy, especially in terms of RE, jejunal interposition has obvious advantages, which is an ideal way to reconstruct the digestive tract in patients with AEG undergoing proximal gastrectomy.

表1 食管胃结合部腺癌患者近端胃切除后三种不同消化道重建方式的一般资料比较
图1 腹腔镜辅助下近端胃切除三种消化道重建方式
图2 腹腔镜辅助下近端胃切除术中双通道吻合
表2 食管胃结合部腺癌患者近端胃切除后三种不同消化道重建方式的围手术期指标比较(±s)
表3 食管胃结合部腺癌患者近端胃切除后三种不同消化道重建方式的术前与术后6个月营养状态比较(g/L,±s)
表4 食管胃结合部腺癌患者近端胃切除后三种不同消化道重建方式的同组手术前后营养状态t检验
表5 食管胃结合部腺癌患者近端胃切除后三种不同消化道重建方式的术后并发症比较(例)
表6 食管胃结合部腺癌患者三组间比较差异有统计学意义的指标进一步行t检验的P
图3 三种重建方式的术后碘油造影
1
蒿汉坤,洪军. 全腔镜时代SiewertⅡ型食管胃结合部腺癌的清扫及重建策略[J/CD]. 中华腔镜外科杂志(电子版), 2019, 12(5): 267-271.
2
Buas MF, Vaughan TL. Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease [J]. Semin Radiat Oncol, 2013, 23(1): 3-9.
3
Kusano C, Gotoda T, Khor CJ, et al. Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in a large tertiary referral center in Japan [J]. J Gastroenterol Hepatol, 2008, 23(11): 1662-1665.
4
Liu K, Yang K, Zhang W, et al. Changes of esophagogastric junctional adenocarcinoma and gastroesophageal reflux disease among surgical patients during 1988-2012: a single-institution, high-volume experience in china [J]. Annals of surgery, 2016, 263(1): 88-95.
5
李尤,王子卫. 食管胃结合部腺癌的研究进展[J]. 医学信息,2019, 32(13): 39-45.
6
胡祥. 第5版日本《胃癌治疗指南》拔萃[J]. 中国实用外科杂志,2018, 38(4): 396-406.
7
Yamashita H, Seto Y, Sano T, et al. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma [J]. Gastric Cancer, 2017, 20(1): 69-83.
8
胡祥. 近端胃切除术后消化道重建方式选择及评价[J]. 中国实用外科杂志,2012, 32(8): 609-612.
9
Yasuda A, Yasuda T,Imamoto H, et al. A newly modified esophagogastrostomy with a reliable angle of His by placing a gastric tube in the lower mediastinum in laparoscopy-assisted proximal gastrectomy [J]. Gastric Cancer, 2015, 18(4): 850-858.
10
Takeshita K, Sekita Y, Tani M. Medium-and long-term results of jejunal pouch reconstruction after a total and proximal gastrectomy [J]. Surgery today, 2007, 37(9): 754-761.
11
Ko HJ, Kim KH, Lee SH, et al. Can proximal gastrectomy with double-tract reconstruction replace total gastrectomy. a propensity score matching analysis [J]. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2019, 24 (6):516-524.
12
Ahn SH, Jung DH, Son SY, et al. Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer [J]. Gastric Cancer, 2014, 17(3): 562-570.
13
Ichikawa D, Komatsu S, Kubota T, et al. Long-term outcomes of patients who underwent limited proximal gastrectomy [J]. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2014, 17(1): 141-145.
14
徐泽宽,王林俊,徐皓. 全腹腔镜食管胃结合部肿瘤切除术后消化道重建方式的争议与共识 [J]. 中国实用外科杂志,2018, 38(2): 167-171.
15
张勇,高平,王胜. 食管、贲门癌切除机械吻合术后反流性食管炎的临床研究[J]. 宁夏医学杂志,2009, 31(1): 51-52.
16
Tanaka K, Ebihara Y, Kurashima Y, et al. Laparoscopic proximal gastrectomy with oblique jejunogastrostomy [J]. Langenbecks Arch Surg, 2017, 402(6): 995-1002.
17
Kumagai K, Shimizu K, Yokoyama N, et al. Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan [J]. Surgery today, 2012, 42(5): 411-418.
18
Ahn SH, Jung DH, Son SY, et al. Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer [J]. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2014, 17(3): 562-570.
19
Nomura E, Lee SW, Kawai M, et al. Functional outcomes by reconstruction technique following laparoscopic proximal gastrectomy for gastric cancer: double tract versus jejunal interposition [J]. World J Surg Oncol, 2014, 12 (1):20-20.
Zhao P, Xiao SM, Tang LC, et al. Proximal gastrectomy with jejunal interposition and TGRY anastomosis for proximal gastric cancer [J]. World J Gastroenterol, 2014, 20(25): 8268-8273.
20
Nozaki I, Hato S, Kobatake T, et al. Long-term outcome after proximal gastrectomy with jejunal interposition for gastric cancer compared with total gastrectomy [J]. World J Surg, 2013, 37(3): 558-564.
21
Katai H, Morita S, Saka M, et al. Long-term outcome after proximal gastrectomy with jejunal interposition for suspected early cancer in the upper third of the stomach [J]. Br J Surg, 2010, 97(4): 558-562.
[1] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[2] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[3] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[4] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[5] 蔡永芹, 王君菊, 张敬敬. 不同下纵隔淋巴结清扫顺序在Siewert Ⅱ型食管胃结合部腺癌中应用效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 562-565.
[6] 韩超, 解曙哲, 赵强, 宋应明, 连长红. 腹腔镜辅助近端胃切除双通道吻合技术治疗Siewert Ⅱ型食管胃结合部腺癌的近期疗效分析[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(03): 296-299.
[7] 邹庆涛, 张洪贞, 尹作文, 喻军, 张鹏. 食管胃结合部腺癌根治术三种消化道重建方式的临床效果评价[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(05): 545-548.
[8] 欧雷, 罗之谦, 陈旺文, 龙凯军. 改良食管残胃吻合术在近端胃切除术治疗食管胃结合部癌中预防反流的临床效果[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(04): 403-406.
[9] 邹庆涛, 张洪贞, 尹作文, 喻军, 张鹏. 腹腔镜辅助全胃切除术与近端胃切除术治疗Siewert型食管胃结合部腺癌的近期及远期效果对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(04): 395-398.
[10] 张俊飞, 宋新梅, 谢文杰, 杨茜, 牛帅. 腹腔镜全胃切除术不同消化道重建方法对患者术后胆囊功能及胆结石发生的对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(02): 192-195.
[11] 顾熙, 徐子宇, 周澍, 张吴楼, 张业鹏, 林昊, 刘宗航, 嵇振岭, 郑立锋. 腹股沟疝腹膜前间隙无张力修补术后补片感染10 例报道[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 665-669.
[12] 李临川, 李戊阳, 程玉刚, 朱健康, 张光永. 近端胃切除术后消化道重建方式的现状与展望[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(03): 135-140.
[13] 王龙龙, 王灼印, 李瑞欣, 王敬涛, 张云飞, 汲翔, 孙于翔, 王国俊. 俯卧位胸内手工吻合在食管受累≥4 cm的食管胃结合部腺癌中的应用[J/OL]. 中华腔镜外科杂志(电子版), 2022, 15(06): 331-335.
[14] 黄文鹏, 李莉明, 高剑波. 食管胃结合部腺癌的研究现状[J/OL]. 中华消化病与影像杂志(电子版), 2023, 13(03): 160-166.
[15] 贾卓奇, 李硕, 陈健, 张广健, 付军科. 新辅助治疗后胸腹腔镜下Ivor-Lewis食管胃结合部腺癌根治术1例并文献复习[J/OL]. 中华胸部外科电子杂志, 2023, 10(02): 111-116.
阅读次数
全文


摘要