早期胃癌行腹腔镜近端胃切除食管胃单肌瓣吻合术7例疗效分析

Efficacy analysis of laparoscopic proximal gastrectomy with single-flap esophagogastrostomy in 7 cases of early gastric cancer

摘要:

背景与目的 近年来，保留功能的近端胃切除和重建是治疗早期胃癌的重要方法，但尚无统一的手术方式，且各类新术式的近远期效果尚不完全明确。本研究分析早期胃癌行腹腔镜近端胃切除食管胃单肌瓣吻合术的安全性及近期疗效。方法 回顾性分析2021年12月─2022年12月苏州大学附属第一医院连续收治的7例行腹腔镜近端胃切除食管胃单肌瓣吻合的患者临床数据及随访资料。观察患者围手术期安全性、术后6个月吻合口反流和狭窄情况及相关营养指标，并将该组患者术后1年的营养相关指标与同期行全胃切除Roux-en-Y吻合的11例早期胃癌患者比较。结果 7例患者均在腹腔镜下完成近端胃切除食管胃单肌瓣吻合。手术时间（212.9±20.6）min，其中吻合时间（54.7±10.5）min；术中平均出血量（28.6±9.0）mL。住院期间均无Clavien-Dindo Ⅲ级及以上并发症发生。所有患者均无明显反流症状，1例患者术后3个月出现吻合口狭窄症状。患者术前与术后6个月的血红蛋白浓度、白蛋白浓度、前白蛋白浓度、总蛋白浓度及淋巴细胞计数差异均无统计学意义（均P>0.05）。近端胃切除食管胃单肌瓣患者术后1年的体质量、第三腰椎（L3）骨骼肌面积、L3内脏脂肪面积、血红蛋白浓度的下降百分比均低于同期早期胃癌行全胃切除Roux-en-Y吻合的患者（均P<0.05）。结论 腹腔镜近端胃切除食管胃单肌瓣吻合术是一种安全可行的早期胃癌手术方式，抗反流效果确切，但需避免吻合口狭窄发生。此手术方式对早期胃癌患者术后营养状态影响低于全胃切除。

Abstract:

Background and Aims In recent years, function-preserving proximal gastrectomy with reconstruction has become an important approach for the treatment of early gastric cancer. However, there is no standardized surgical technique, and the short- and long-term outcomes of various new procedures remain unclear. This study was performed to evaluate the safety and short-term efficacy of laparoscopic proximal gastrectomy plus esophagogastrostomy with single-flap technique for early gastric cancer.Methods The clinical data and follow-up records of 7 patients who underwent laparoscopic proximal gastrectomy with single-flap esophagogastrostomy in the First Affiliated Hospital of Soochow University between December 2021 and December 2022 were retrospectively analyzed. Perioperative safety, postoperative reflux, anastomotic stricture at 6 months, and related nutritional parameters were assessed. The nutrition-related indicators of this group of patients were compared with those of 11 patients who underwent total gastrectomy with Roux-en-Y anastomosis for early gastric cancer during the same period.Results All 7 patients successfully underwent laparoscopic proximal gastrectomy with single-flap esophagogastrostomy. The average operative time was (212.9±20.6) min, with anastomosis taking (54.7±10.5) min; the mean intraoperative blood loss was (28.6±9.0) mL. No Clavien-Dindo grade Ⅲ or higher complications were observed during hospitalization. None of the patients experienced significant reflux symptoms, although 1 patient developed anastomotic stricture 3 months after operation. There were no statistically significant differences in hemoglobin concentration, albumin level, prealbumin level, total protein concentration, and lymphocyte count between preoperative and 6-month postoperative measurements (all P>0.05). Compared to patients who underwent total gastrectomy with Roux-en-Y anastomosis, those who had the proximal gastrectomy with single-flap esophagogastrostomy showed a lower percentage decrease in body weight, skeletal muscle area at the third lumbar vertebra (L3), visceral fat area at L3, and hemoglobin concentration at 1 year after operation (all P<0.05).Conclusion Laparoscopic proximal gastrectomy with single-flap esophagogastrostomy is a safe and feasible surgical option for early gastric cancer, offering effective anti-reflux outcomes while minimizing the risk of anastomotic stricture. This procedure has a lower impact on postoperative nutritional status compared to total gastrectomy.