Kamikawa吻合术在老年胃癌患者近端胃切除术中的应用效果及安全性评价^*

Evaluation of the efficacy and safety of kamikawa anastomosis in proximal gastrectomy for elderly patients with gastric cancer

摘要

目的 探讨Kamikawa吻合术 (食管胃吻合双肌瓣成形术) 在老年胃癌患者近端胃癌根治术中的应用效果和安全性。方法 选取2023年1—12月北京大学第一医院太原医院胃肠外科收治的120例老年胃癌患者作为研究对象, 按照随机数字表法, 将纳入患者随机分为观察组和对照组, 各60例。对照组行全腹腔镜近端胃癌根治+食管残胃吻合术, 观察组行全腹腔镜近端胃癌根治+Kamikawa吻合术。比较两组术前一般资料、手术资料 (手术时间、术中出血量、切口长度、吻合时间)、术后情况 (术后肛门排气时间、术后首次进食时间、术后住院时间、总治疗费用)、随访情况 (包括术后并发症、安全性评价、术后疗效分析)。结果 观察组手术时间长于对照组 (P<0.05), 但两组术中出血量、切口长度、吻合时间比较, 差异均无统计学意义 (P>0.05)。观察组的首次流质饮食时间、首次肛门排气时间、术后住院时间均短于对照组 (P<0.05), 手术总费用低于对照组 (P<0.05)。观察组反流性食管炎发生率低于对照组 (P<0.05)。观察组1例患者发生肿瘤复发与转移, 对照组有2例患者发生复发 (无转移), 两组复发转移情况比较, 差异无统计学意义 (P>0.05)。对照组因肺部感染死亡1例, 创口局部感染1例, 观察组创口局部感染1例, 两组术后并发症发生情况比较, 差异无统计学意义 (P>0.05)。观察组患者的主观整体营养评估量表及生活质量评分均高于对照组 (P<0.05)。结论 Kamikawa吻合术可用于老年食管胃结合部腺癌患者的全腹腔镜近端胃切除术后的消化道重建, 近期疗效好。

Abstract

Objective To explore the efficacy and safety of Kamikawa anastomosis (esophagogastric anastomosis with double muscle flap formation) in radical proximal gastrectomy for elderly patients with gastric cancer. Methods A total of 120 elderly patients with gastric cancer admitted to the department of gastrointestinal surgery of Peking University First Hospital Taiyuan Hospital from January to December 2023 were selected as the research subjects. According to the random number table method, the included patients were randomly divided into the observation group and the control group, with 60 cases in each group. The control group underwent total laparoscopic proximal gastrectomy + esophagogastric anastomosis, while the observation group underwent total laparoscopic proximal gastrectomy + Kamikawa anastomosis. The preoperative general data, surgical data (operation time, intraoperative blood loss, incision length, anastomosis time), postoperative conditions (postoperative time to anal gas release, postoperative first meal time, postoperative hospital stay, total treatment cost), and follow-up conditions (including postoperative complications, safety evaluation, postoperative efficacy analysis) were compared between the two groups. Results The operation time of the observation group was longer than that of the control group (P<0.05), but there were no statistically significant differences in intraoperative blood loss, incision length, and anastomosis time between the two groups (P>0.05). The first liquid diet time, first anal gas release time, and postoperative hospital stay of the observation group were shorter than those of the control group (P<0.05), and the total operation cost was lower than that of the control group (P<0.05). The incidence of reflux esophagitis in the observation group was lower than that in the control group (P<0.05). One patient in the observation group had tumor recurrence and metastasis; two patients in the control group had recurrence (no metastasis). There was no statistically significant difference in the recurrence and metastasis situation between the two groups (P>0.05). One patient in the control group died due to pulmonary infection, and another had local wound infection. One patient in the observation group had a local wound infection. The occurrence of postoperative complications between the two groups was not statistically significant (P>0.05). The subjective overall nutritional assessment scale and quality of life score of the patients in the observation group were higher than those in the control group (P<0.05). Conclusion Kamikawa anastomosis can be used for the digestive tract reconstruction after total laparoscopic proximal gastrectomy for elderly patients with adenocarcinoma of the esophagogastric junction, and the short-term efficacy is good.

关键词

Kamikawa吻合术 / 近端胃切除术 / 胃肿瘤 / 疗效评价

Key words

Kamikawa anastomosis / Proximal gastrectomy / Gastric cancer / Efficacy evaluation

参考文献

[1] Sadu Singh R S, Loo G H, Muthkumaran G, et al. Proximal margin involvement following total gastrectomy for seiwert ⅲ adenocarcinoma: a management dilemma[J]. Cureus, 2024, 16(7): e64945.

[2] 杨东, 孟祥宇, 赵岩, 等 . 食管胃吻合双肌瓣成形在全腹腔镜近端胃癌根治术中的应用价值[J]. 中华消化外科杂志, 2021, 20(9): 994-1000.

[3] Yang D, Meng X Y, Zhao Y, et al. Application value of esophagogastric anastomosis with double muscle flap plasty in total laparoscopic radical resection of proximal gastric cancer[J]. Chin J Digest Surg, 2021, 20(9): 994-1000.

[4] 王伟东, 卫江鹏, 高瑞祺, 等 . 腹腔镜下近端胃切除食管胃吻合单肌瓣成形术初步体会[J]. 中华胃肠外科杂志, 2022, 25(5): 462-465.

[5] Wang W D, Wei J P, Gao R Q, et al. Preliminary experience of laparoscopic proximal gastrectomy with esophagogastrostomy single flap technique[J]. Chin J Gastrointest Surg, 2022, 25(5): 462-465.

[6] Yang D, Liu Y L, Meng X Y, et al. Complete laparoscopic and Da Vinci robot esophagogastric anastomosis double muscle flap plasty for radical resection of proximal gastric cancer[J]. Front Oncol, 2024, 14: 1395549.

[7] 朱晓峰, 熊文俊, 郑燕生, 等 . 腹腔镜食管胃吻合肌瓣成形术对于直径>5 cm食管胃结合部肿瘤近端胃切除术后消化道重建安全可行[J]. 中华胃肠外科杂志, 2021, 24(2): 167-172.

[8] Zhu X F, Xiong W J, Zheng Y S, et al. Safety and feasibility of laparoscopic double—flap technique in digestive tract reconstruction after proximal gastrectomy for esophagogastric junction tumors larger than 5 cm[J]. Chin J Gastrointest Surg, 2021, 24(2): 167-172.

[9] 杨佳宾, 张志平, 劳锡锋, 等 . 近端胃切除食管胃吻合双瓣成形术的研究进展[J]. 中华普通外科杂志, 2020, 35(12): 985-988.

[10] Yang J B, Zhang Z P, Lao X F, et al. Research progress of proximal gastrectomy esophageal gastral anastomosis bivalve plastomy[J]. Chin J General Surg, 2020, 35(12): 985-988.

[11] 章旭, 邵鹏, 周斌, 等 . 近端胃癌保功能手术后消化道重建及术后功能评价[J]. 中国肿瘤外科杂志, 2021, 13(5): 436-440.

[12] Zhang X, Shao P, Zhou B, et al. Function—preserving reconstruction strategy and function evaluation post proximal gastrectomy[J]. Chin J Surg Oncol, 2021, 13(5): 436-440.

[13] 《近端胃切除消化道重建中国专家共识》编写委员会 . 近端胃切除消化道重建中国专家共识(2020版)[J]. 中华胃肠外科杂志, 2020, 27(10): 983-995.

[14] The drafting committee of the Chinese expert consensus on proximal gastrectomy and gastrointestinal reconstruction. Chinese consensus on digestive tract reconstruction after proximal gastrectomy(2020 edition)[J]. Chin J Gastrointest Surg, 2020, 27(10): 983-995.

[15] Wu C Y, Huang Q Z, Ye K . Comparison of clinical efficacy between modified Kamikawa anastomosis in laparoscopic proximal gastrectomy and Roux—en—Y anastomosis in laparoscopic total gastrectomy[J]. Sci Rep, 2024, 14(1): 17181.

[16] 严超, 陆晟, 何相宜, 等 . 基于浆肌双瓣技术的食管胃吻合应用于腹腔镜辅助近端胃切除术(附1例贲门部胃肠间质瘤报告并文献复习)[J]. 外科理论与实践, 2020, 25(1): 50-55.

[17] Yan C, Lu S, He X Y, et al. Esophagogastrostomy using seromuscular double—flap technique following laparoscopy—assisted proximal gastrectomy: a case report of gastrointestinal stromal tumor at the gastric cardia and literature[J]. J Surg Concepts Pract, 2020, 25(1): 50-55.

[18] Wu C Y, Lin J A, Ye K . Clinical efficacy of modified Kamikawa anastomosis in patients with laparoscopic proximal gastrectomy[J]. World J Gastrointest Surg, 2024, 16(1): 113-123.

[19] Takenaka S, Tsuji T, Doden K, et al. Advanced esophagogastric junction mixed neuroendocrine—non—neuroendocrine neoplasm with long—term recurrence—free survival[J]. Surg Case Rep, 2024, 10(1): 217.

[20] 宗亮, 崔鹏, 魏伟, 等 . 改良Kamikawa吻合术在近端胃切除术后消化道重建中的应用[J]. 中华胃肠外科杂志, 2021, 24(8): 691-697.

[21] Zong L, Cui P, Wei W, et al. Application of modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy[J]. Chin J Gastrointest Surg, 2021, 24(8): 691-697.

[22] 王道荣, 王伟 . 腹腔镜近端胃癌根治术消化道重建的历史与现状[J]. 肿瘤防治研究, 2022, 49(7): 644-648.

[23] Wang D R, Wang W. History and current situation of digestive tract reconstruction after laparoscopic proximal radical gastrectomy[J]. Cancer Res Prev Treat, 2022, 49(7): 644-648.

[24] Tustumi F, Pereira M A, Lisak A S, et al. The value of preoperative prognostic nutritional index in gastric cancer after curative resection[J]. Arq Bras Cir Dig, 2024, 37: e1805.

基金资助

^*国家自然科学基金资助项目(82273539)

山西省大健康产业高质量发展科研专项课题 (第二批) 研究项目(DJKZXKT2023207)