摘要
目的探讨OrVil^(TM)与Overlap食管空肠吻合在食管胃结合部腺癌(AEG)腹腔镜根治性全胃切除术中的临床价值。方法采用回顾性队列研究方法。收集2017年7月至2022年8月吉林大学第一医院收治的112例AEG患者的临床病理资料;男87例,女25例;年龄为(64±8)岁。112例患者均行完全腹腔镜全胃切除+D2淋巴结清扫术,其中61例食管空肠吻合采用OrVil^(TM)法,设为OrVil^(TM)组;51例食管空肠吻合采用Overlap法,设为Overlap组。观察指标:(1)手术情况。(2)术后并发症情况。(3)影响患者行OrVil^(TM)食管空肠吻合的因素分析。正态分布的计量资料以x^(-)±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(Q1,Q3)表示,组间比较采用非参数检验。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。多因素分析采用Logistic回归模型。结果(1)手术情况。OrVil^(TM)组和Overlap组患者食管受侵犯长度、肿瘤长径分别为1.0(0.7,2.0)cm、(6.3±2.7)cm和0.2(0.1,0.5)cm、(4.7±2.2)cm,两组患者上述指标比较,差异均有统计学意义(Z=-6.14,t=3.26,P<0.05)。(2)术后并发症情况。OrVil^(TM)组和Overlap组患者Clavien-Dindo分级≥Ⅲa级并发症、呼吸系统总并发症、胸腔积液分别为13、17、13例和4、5、4例,两组患者上述指标比较,差异均有统计学意义(χ^(2)=3.91,5.74,3.91,P<0.05)。OrVil^(TM)组和Overlap组患者术后30 d内再入院分别为3例和1例,均经对症治疗后康复;术后死亡分别为2例和0例。(3)影响患者行OrVil^(TM)食管空肠吻合的因素分析。多因素分析结果显示:食管受侵犯长度是患者行OrVil^(TM)食管空肠吻合的独立影响因素(优势比=8.25,95%可信区间为3.41~19.96,P<0.05)。结论与Overlap食管空肠吻合比较,腹腔镜根治性全胃切除术中行OrVil^(TM)食管空肠吻合可使AEG患者肿瘤近端切缘获益,但OrVil^(TM)吻合发生Clavien-Dindo分级≥Ⅲa级并发症、呼吸系统总并发症、胸腔积液的比例增加;食管受侵犯长度是患者行OrVil^(TM)食管空肠吻合的独立影响因素。
Objective To investigate the clinical value of esophageal-jejunal OrVil^(TM)anastomosis and Overlap anastomosis in laparoscopic radical total gastrectomy of adenocarcinoma of esophagogastric junction(AEG).Methods The retrospective cohort study was conducted.The clinicopathological data of 112 patients with AEG who were admitted to the First Hospital of Jilin University from July 2017 to August 2022 were collected.There were 87 males and 25 females,aged(64±8)years.All 112 patients underwent laparoscopic total gastrectomy and D,lymphadenectomy,in which 61 cases with esophageal-jejunal Orvil^(TM)anastomosis were divided into the OrvilM group,51 cases with esophageal-jejunal Overlap anastomosis were divided into the Overlap group.Observation indicators:(1)surgical situations;(2)postoperative complications;(3)influencing factors for patients undergoing esophageal-jejunal Orvil^(TM)anastomosis.Measurement data with normal distribution were represented as Mean+SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(Q,Q.),and comparison between groups was conducted using the non-parameter test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Logistic regression model was used for multivariate analysis.Results(1)Surgical situations.The esophageal invasion length and tumor diameter was 1.0(0.7,2.0)cm and(6.3±2.7)cm in patients of the Orvil^(TM)group,versus 0.2(0.1,0.5)cm and(4.7±2.2)cm,respectively,in patients of the Overlap group,showing significant differences in the above indicators between the two groups(Z=-6.14,t=3.26,P<0.05).(2)Postoperative complications.Cases with complications≥Ila grade of Clavien-Dindo classification,cases with respiratory system complications,cases with hydrothorax were 13,17,13 in the OrviM group,versus 4,5,4 in the Overlap group,showing significant differences in the above indicators between the two groups(χ^(2)=3.91,5.74,3.91,P<0.05).Cases underwent readmission within postoperative 30 days were 3 and 1 in the Orvil^(TM)group and the Overlap group,respectively,and all patients recovered after symptomatic treatment.There were 2 cases died after operation in the Orvil^(TM)group and none of patients died after operation in the Overlap group.(3)Influencing factors for patients undergoing esophageal-jejunal Orvil^(TM)anastomosis.Results of multivariate analysis showed that esophageal invasion length was an independent factor influencing for patients undergoing esophageal-jejunal Orvil^(TM)anastomosis(odds ratio=8.25,95%confidence interval as 3.41-19.96,P<0.05).Conclusions Compared with esophageal-jejunal Overlap anastomosis,choosing the esophageal-jejunal Orvil^(TM)anastomosis during laparoscopic radical total gastrectomy can take benefit to the proximal margin of patients with AEG.However,the ratios of complications≥Ⅲa grade of Clavien-Dindo classification,respiratory system complications and hydrothorax associated to Orvil^(TM)anastomosis are relatively increased.Esophageal invasion length is an independent influencing factor for patients undergoing esophageal-jejunal Orvil^(TM)anastomosis.
作者
马胜杰
赵银泉
夏明杰
何亮
佟伟华
国瑀辰
李爽
王权
Ma Shengjie;Zhao Yinquan;Xia Mingjie;He Liang;Tong Weihua;Guo Yuchen;Li Shuang;Wang Quan(Department of Gastrocolorectal Surgery,General Surgery Center,the First Hospital of Jilin University,Changchun 130012,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2023年第3期383-390,共8页
Chinese Journal of Digestive Surgery
基金
吉林省科技发展计划项目(20200802010GH)
白求恩医学工程与仪器中心项目(BQE GCZX2021010)。
作者简介
通信作者:王权,Email:wquan@jlu.edu.cn。
