食管空肠overlap与π形吻合术后短期疗效及患者生活质量的对比研究
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摘要
目的:对比全腹腔镜全胃切除术后食管空肠overlap吻合与π形吻合术的短期疗效及患者生活质量。方法:回顾性收集2012年1月—2017年8月期间符合要求的104例接受全腹腔镜全胃切除的胃腺癌患者临床资料,其中59例行食管空肠overlap吻合(overlap吻合组),45例行π形吻合(π形吻合组),比较两组患者的临床数据及其术前与术后1年的生活质量调查问卷资料。结果:两组患者术前资料具有可比性。π形吻合组平均吻合时间明显短于overlap吻合组(28.9 min vs.41.5 min,P<0.05),但两组平均手术时间无明显差异(287.6 min vs. 315.6min,P>0.05)。两组在术中失血量、切口长度、术后短期疗效及术后1年营养状况、生活质量方面均无统计学差异(均P>0.05)。结论:全腹腔镜全胃切除术食管空肠overlap吻合与π形吻合均安全可行。吻合方式的不同并没有对术后短期疗效及患者生活质量产生明显影响。在临床工作中,可根据患者具体身体状况及肿瘤的生长部位等因素对两种吻合方法的应用进行选择。
Objective: To compare the short-term effi cacy and quality of life(QOL) between patients undergoing overlap esophagojejunostomy and π-shaped esophagojejunostomy after totally laparoscopic total gastrectomy(TLTG).Methods: The clinical data of 104 patients with gastric adenocarcinoma meeting the requirements undergoing TLTG from January 2012 to August 2017 were retrospectively collected. Of the patients, 59 cases underwent overlap esophagojejunostomy(overlap anastomosis group) and 45 cases underwent π-shaped esophagojejunostomy(π-shaped anastomosis group). Th e clinical data and results of QOL questionnaires beforeand one year aft er operation were compared between the two groups of patients.Results: The preoperative data between the two groups were comparable. The average time for anastomosis in π group was signifi cantly shorter than that in overlap group(28.9 min vs. 41.5 min, P<0.05), but the average operative time showed no signifi cant diff erence between the two groups(287.6 min vs. 315.6 min, P>0.05). Th ere were no statistically diff erences in terms of intraoperative blood loss, length of incision, postoperative short-term results, and postoperative one-year nutritional status and QOL between the two groups(all P>0.05).Conclusion: Both overlap and π-shaped esophagojejunostomy aft er TLTG are safe and feasible. Th e diff erence in anastomotic method will not significantly affect the short-term results and QOL of the patients. In clinical practice, the two types of anastomotic methods can be selected according to the specific factors such as the conditions of the patients and the location of the tumor.
Objective: To compare the short-term effi cacy and quality of life(QOL) between patients undergoing overlap esophagojejunostomy and π-shaped esophagojejunostomy after totally laparoscopic total gastrectomy(TLTG).Methods: The clinical data of 104 patients with gastric adenocarcinoma meeting the requirements undergoing TLTG from January 2012 to August 2017 were retrospectively collected. Of the patients, 59 cases underwent overlap esophagojejunostomy(overlap anastomosis group) and 45 cases underwent π-shaped esophagojejunostomy(π-shaped anastomosis group). Th e clinical data and results of QOL questionnaires beforeand one year aft er operation were compared between the two groups of patients.Results: The preoperative data between the two groups were comparable. The average time for anastomosis in π group was signifi cantly shorter than that in overlap group(28.9 min vs. 41.5 min, P<0.05), but the average operative time showed no signifi cant diff erence between the two groups(287.6 min vs. 315.6 min, P>0.05). Th ere were no statistically diff erences in terms of intraoperative blood loss, length of incision, postoperative short-term results, and postoperative one-year nutritional status and QOL between the two groups(all P>0.05).Conclusion: Both overlap and π-shaped esophagojejunostomy aft er TLTG are safe and feasible. Th e diff erence in anastomotic method will not significantly affect the short-term results and QOL of the patients. In clinical practice, the two types of anastomotic methods can be selected according to the specific factors such as the conditions of the patients and the location of the tumor.
引文
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[2]柳国富,柯志刚,徐江浩,等.完全腹腔镜与开腹全胃切除的疗效及术后并发症分析[J].中国普通外科杂志,2017,26(10):1324-1329.doi:10.3978/j.issn.1005-6947.2017.10.016.Liu GF,Ke ZG,Xu JH,et al.Totally laparoscopic versus open radical gastrectomy:an analysis of efficacy and postoperative complications[J].Chinese Journal of General Surgery,2017,26(10):1324-1329.doi:10.3978/j.issn.1005-6947.2017.10.016.
[3]Hu Y,Huang C,Sun Y,et al.Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer:A Randomized Controlled Trial[J].J Clin Oncol,2016,34(12):1350-1357.doi:10.1200/JCO.2015.63.7215.
[4]Uyama I,Sugioka A,Fujita J,et al.Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer[J].Gastric Cancer,1999,2(4):230-234.doi:10.1007/s101209900041.
[5]Chen K,He Y,Cai JQ,et al.Comparing the short-term outcomes of intracorporeal esophagojejunostomy with extracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer[J].BMC Surg,2016,16:13.doi:10.1186/s12893-016-0130-9.
[6]Xu X,Huang C,Mou Y,et al.Intra-corporeal hand-sewn esophagojejunostomy is a safe and feasible procedure for totally laparoscopic total gastrectomy:short-term outcomes in 100consecutive patients[J].Surg Endosc,2018,32(6):2689-2695.doi:10.1007/s00464-017-5964-4.
[7]Okabe H,Tsunoda S,Tanaka E,et al.Is laparoscopic total gastrectomy a safe operation?A review of various anastomotic techniques and their outcomes[J].Surg Today,2015,45(5):549-558.doi:10.1007/s00595-014-0901-9.
[8]Gong CS,Kim BS,Kim HS.Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer:A single-center experience[J].World J Gastroenterol,2017,23(48):8553-8561.doi:10.3748/wjg.v23.i48.8553.
[9]Sugiyama M,Oki E,Ogaki K,et al.Clinical Outcomes of Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy:A Multicenter Study[J].Surg Laparosc Endosc Percutan Tech,2017,27(4):e87-e91.doi:10.1097/SLE.0000000000000435.
[10]Umemura A,Koeda K,Sasaki A,et al.Totally laparoscopic total gastrectomy for gastric cancer:literature review and comparison of the procedure of esophagojejunostomy[J].Asian J Surg,2015,38(2):102-112.doi:10.1016/j.asjsur.2014.09.006.
[11]Inaba K,Satoh S,Ishida Y,et al.Overlap method:novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy[J].J Am Coll Surg,2010,211(6):e25-29.doi:10.1016/j.jamcollsurg.2010.09.005.
[12]Kwon IG,Son YG,RyuSW.Novel Intracorporeal Esophagojejunostomy Using Linear Staplers During Laparoscopic Total Gastrectomy:pi-Shaped Esophagojejunostomy,3-in-1Technique[J].J Am Coll Surg,2016,223(3):e25-29.doi:10.1016/j.jamcollsurg.2016.06.011.
[13]臧潞,郑民华,薛佩,等.完全腹腔镜根治性全胃切除术后食管空肠三角吻合的近期疗效[J].中华消化外科杂志,2014,13(2):134-138.doi:10.3760/cma.j.issn.1673-9752.2014.02.013.Zang L,Zheng MH,Xue P,et al.Short-term efficacy of esophagojejunostomy by delta-shaped anastomosis in totally laparoscopic radical total gastrectomy[J].Chinese Journal of Digestive Surgery,2014,13(2):134-138.doi:10.3760/cma.j.issn.1673-9752.2014.02.013.
[14]Clavien PA,Sanabria JR,Strasberg SM.Proposed classification of complications of surgery with examples of utility in cholecystectomy[J].Surgery,1992,111(5):518-526.
[15]Armstrong D,Bennett JR,Blum AL,et al.The endoscopic assessment of esophagitis:a progress report on observer agreement[J].Gastroenterology,1996,111(1):85-92.
[16]Aaronson NK,Ahmedzai S,Bergman B,et al.The European Organization for Research and Treatment of Cancer QLQ-C30:a quality-of-life instrument for use in international clinical trials in oncology[J].J Natl Cancer Inst,1993,85(5):365-376.
[17]Vickery CW,Blazeby JM,Conroy T,et al.Development of an EORTC disease-specifi c quality of life module for use in patients with gastric cancer[J].Eur J Cancer,2001,37(8):966-971.
[18]姜宝法,徐涛,刘春晓,等.胃癌患者生活质量问卷(QLQ-STO22)中文版的制定[J].中国心理卫生杂志,2005,19(5):310-312.doi:10.3321/j.issn:1000-6729.2005.05.005.Jiang BF,Xu T,Liu CX,et al.Development of Chinese Version of QLQ-STO22[J].Chinese Mental Health Journal,2005,19(5):310-312.doi:10.3321/j.issn:1000-6729.2005.05.005.
[19]王建平,陈仲庚,林文娟,等.中国癌症病人生活质量的测定--EORTC QLQ-C30在中国的试用[J].心理学报,2000,32(4):438-442.Wang JP,Chen ZG,Lin WJ,et al.Assessment of Quality of Life in Cancer Patients:EORTC QLQ-C30 for Use in China[J].Acta Psychologica Sinica,2000,32(4):438-442.
[20]杨力,徐泽宽,徐皓,等.食管空肠π吻合在全腹腔镜全胃切除术中的应用价值[J].中华消化外科杂志,2017,16(5):522-526.doi:10.3760/cma.j.issn.1673-9752.2017.05.016.Yang L,Xu ZK,Xu H,et al.Application value of theπ-shaped esophagojejunostomy in totally laparoscopic total gastrectomy[J].Chinese Journal of Digestive Surgery,2017,16(5):522-526.doi:10.3760/cma.j.issn.1673-9752.2017.05.016.
[21]王楠,郑波波,翟玉龙,等.改良Overlap法在全腹腔镜根治性全胃切除术消化道重建中的应用价值[J].中华消化外科杂志,2017,16(9):949-954.doi:10.3760/cma.j.issn.1673-9752.2017.09.014.Wang N,Zheng BB,Zhai YL,et al.Application value of the modified Overlap method in digestive tract reconstruction of totally laparoscopic total gastrectomy[J].Chinese Journal of Digestive Surgery,2017,16(9):949-954.doi:10.3760/cma.j.issn.1673-9752.2017.09.014.
[22]Inokuchi M,Otsuki S,Fujimori Y,et al.Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy[J].World J Gastroenterol,2015,21(32):9656-9665.doi:10.3748/wjg.v21.i32.9656.
[23]杨力,徐泽宽,徐皓,等.胃癌全腹腔镜下全胃切除食管空肠π形吻合临床体会[J].中华胃肠外科杂志,2016,19(8):948-950.doi:10.3760/cma.j.issn.1671-0274.2016.08.031.Yang L,Xu ZK,Xu H,et al.Clinical experience inπ-shaped esophagojejunostomy after totally laparoscopic total gastrectomy for gastric cancer[J].Chinese Journal of Gastrointestinal Surgery,2016,19(8):948-950.doi:10.3760/cma.j.issn.1671-0274.2016.08.031.
[24]Matsuda A,Miyashita M,Matsumoto S,et al.Isoperistaltic versus antiperistaltic stapled side-to-side anastomosis for colon cancer surgery:a randomized controlled trial[J].J Surg Res,2015,196(1):107-112.doi:10.1016/j.jss.2015.02.059.
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