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期刊信息/Journal information
中华胃肠外科杂志
中华胃肠外科杂志

汪建平

月刊

1671-0274

china_gisj@vip.163.com

020-38254955

510655

广东省广州市天河区员村二横路26号

中华胃肠外科杂志/Journal Chinese Journal of Gastrointestinal SurgeryCSCD北大核心CSTPCD
查看更多>>1998年5月创刊，中国科协主管，中华医学会、中山大学主办。本刊是我国惟一的胃肠外科专业学术期刊，办刊宗旨为全面系统地反映国内外胃肠外科领域的学术动态，促进胃肠外科的学科发展和学术交流。本刊的主要读者对象为从事胃肠外科、普通外科及相关专业的临床、科研、教学的高、中级医师。设置的栏目有述评、专家笔谈、论著、短篇论著、临床经验、病例报告、术式交流、MDT病例讨论、诊治指南、讲座、综述及医学信息等。
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    经皮内镜下胃（空肠）造口术临床应用中国专家共识（2024版）

    李幼生卜建红
    205-214页
    查看更多>>摘要：为建立长期的肠内营养支持治疗（EN）通道，经皮内镜下胃（空肠）造口术（PEG/J）提供了一种较为安全、有效的微创手术途径。PEG/J依从性好，且可降低反流和吸入性肺炎的发生率，是长期EN的首选方式，目前已得到了广泛的临床应用。但至今尚无相关的操作技术指南或专家共识，来指导临床规范开展这项技术。由中国研究型医院学会肠外肠内营养学专业委员会牵头，组织我国相关领域的专家学者，在国内外相关文献基础上，总结最新临床证据，结合中国专家临床经验，围绕PEG/J的适应证和禁忌证、围手术期管理、操作技术以及相关并发症防治等问题，按照“推荐意见（证据级别和推荐强度）和证据简述”的基本框架分别进行阐述，所有推荐意见及其推荐强度采用国际通用的专家投票方式进行，形成《中国经皮内镜下胃（空肠）造口术临床应用专家共识（2024版）》。本共识在国际实践指南注册平台完成注册申请（IPGRP-2022CN329）。 Percutaneous endoscopic gastrostomy / jejunostomy (PEG/J) is a relatively safe and effective minimally invasive surgical approach to establish long-term enteral nutrition (EN) channels. Due to the good compliance and the reduced incidence of reflux and aspiration pneumonia, PEG/J is the preferred way for long-term EN and has been widely used in clinical applications. However, few technical guidelines or expert consensus guiding the clinical practice of PEG/J have been published. The formation of "Chinese expert consensus on clinical application of percutaneous endoscopic gastrostomy / jejunostomy (2024 edition)" is led by the Committee of Parenteral and Enteral Nutrition, Chinese Research Hospital Association. This consensus is based on the latest clinical evidence as well as the clinical experience of Chinese experts. This consensus is divided into PEG/J indications and contraindication, perioperative management, operational techniques, prevention, and treatment of related complications and other issues. All recommendations and their strengths were carried out by expert-voting method and presented as the basic framework of "Recommended Opinions (level of evidence and strength of recommendation) and Summary of Evidence". This consensus is registered on the International Practice Guide Registration Platform (IPGRP-2022CN329).

    肠内营养经皮内镜下胃（空肠）造口术专家共识

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    晚期胃肠肿瘤患者的营养不良及其治疗

    吴国豪朱雯洁
    215-220页
    查看更多>>摘要：综合治疗的进步使更多胃肠肿瘤患者获得长期生存，当前临床实践中遇到的晚期胃肠肿瘤患者越来越多。在肿瘤负荷、放化疗等治疗措施以及患者基础疾病等众多因素影响下，晚期胃肠肿瘤患者常存在营养不良，给患者的临床结局带来诸多不利影响。晚期胃肠肿瘤患者的营养不良发生机制复杂，常规的营养支持治疗效果欠佳。随着营养支持治疗理念和技术不断进步，治疗手段不断多样化，多学科协作不断加强，晚期胃肠肿瘤患者的营养管理趋于规范、合理，患者的营养状态和临床结局获得有效改善。本文基于最新循证医学证据，结合作者实践经验和体会，探讨晚期胃肠肿瘤患者的营养支持治疗。 The advancement of comprehensive treatment has allowed an increasing number of patients with gastrointestinal tumor to achieve long-term survival. In current clinical practice, there is a growing population of patients with advanced gastrointestinal tumor. Due to various factors, such as tumor burden, treatments including chemotherapy and radiation therapy, as well as underlying diseases, patients with advanced gastrointestinal tumor often experience malnutrition, which negatively impacts their clinical outcomes. The mechanism of malnutrition in patients with advanced gastrointestinal tumor is complex, and conventional nutritional support therapy has shown limited effectiveness. With the continuous progress in the concept and technique of nutritional support therapy, the diversification of treatment strategies, and the strengthening of multidisciplinary collaboration, the nutritional management for patients with advanced gastrointestinal tumor tends to be standardized and rational, leading to effective improvement in patients' nutritional status and clinical outcomes. Based on the latest evidence-based medicine, combined with the author's practical experience and insights, this article aims to explore nutritional support therapy for patients with advanced gastrointestinal tumor.

    胃肠肿瘤,晚期营养不良肌少症恶病质营养支持治疗

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    外科危重症患者胃肠功能障碍营养治疗的难点与对策

    李幼生朱雯洁
    221-224页
    查看更多>>摘要：胃肠功能障碍（GID）在危重症患者中极其常见且预后不良，医学营养治疗是危重症患者重要的治疗策略之一，能显著改善危重症患者的预后。基于既往研究的证据，已经发布了多个有关危重症患者营养治疗的国际指南或共识，但最新的研究证据对已有的推荐提出了挑战。本文总结危重症患者营养治疗的已有研究结果，从外科危重症患者营养治疗前的评估、早期肠内营养治疗和滋养性喂养目标量与达标时间方面的进展和争议等方面进行讨论，以期为读者提供营养治疗的临床实践建议及未来的研究方向参考。 Gastrointestinal dysfunction(GID) is frequently seen in critically ill patients and is associated with worse clinical outcomes. Medical nutrition therapy (MNT) is an integral part of critical care, which may be associated with improved clinical outcomes. The international practical guidelines or consensus for critically ill patients were recommended based on the results of previous investigations. However, the rationale of these recommendations was controversial by the findings of the most recent studies. This review discusses the current developments and controversy about nutritional assessment of critically ill patients prior to medical nutrition therapy, early enteral nutrition, target of trophic feeding, and time to target achievement. This review summarizes the available evidence of MNT in critically ill patients and offers suggestions for clinical practice and future research.

    危重症,外科胃肠功能障碍医学营养治疗早期肠内营养

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    胃肠肿瘤的精准营养治疗

    周达王世杰王新颖朱雯洁...
    225-230页
    查看更多>>摘要：胃肠肿瘤的发生和进展多与个体遗传背景、不良生活方式以及不合理饮食等有关，营养也在其中发挥重要作用。传统的营养支持治疗方式，虽然能够满足部分胃肠肿瘤患者的营养需求，但显然无法适应新形势下胃肠肿瘤的整体治疗需要。精准营养治疗又称个性化营养治疗，是指在考察个体遗传背景、生活特征、代谢指标、肠道微生物特征和生理状态因素的基础上，通过大数据分析，进行安全、高效的个体化营养干预，以达到预防和治疗慢性疾病的目的。本文围绕营养和胃肠肿瘤的关系，探讨精准营养治疗在胃肠肿瘤中的进展，期望实现有效的个性化干预方案，改善胃肠肿瘤患者的临床结局，提升胃肠肿瘤的整体治疗水平。 Apart from individual genetic background, unhealthy lifestyle and diet, etc., nutrition also plays an important role in the occurrence and progression of gastrointestinal tumors. Although some patients with gastrointestinal tumors can be satisfied with the traditional nutritional support, it is apparently inadequate for the systemic management of all patients. Precision nutrition support, also known as personalized nutrition support, refers to safe and efficient individualized nutrition intervention based on the investigation of individual genetic background, life characteristics, metabolic indicators, intestinal microbial characteristics, and physiological status factors through big data analysis for the prevention and treatment of chronic diseases. This review focuses on the relationship between nutrition and gastrointestinal tumors and discusses the progress of precision nutrition support therapy in the gastrointestinal tumors. Based on this, we hope to achieve effective personalized intervention protocols, and improve the clinical outcome and the overall oncology care of gastrointestinal tumors.

    胃肿瘤结直肠肿瘤精准营养治疗

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    短肠综合征相关肠衰竭的营养支持治疗

    柯嘉康亮朱雯洁
    231-235页
    查看更多>>摘要：肠衰竭是指由于肠道功能降低而不能维持正常的消化吸收功能，导致全身代谢紊乱并需要长期补充营养以维持健康及生长的综合征。短肠综合征（SBS）是肠衰竭的主要原因之一，SBS患者存在巨大差异，其营养治疗策略应强调个体化。本文以SBS为主线，结合其解剖和病程特点，介绍肠衰竭患者营养支持治疗的方案及经验。 Intestinal failure is a syndrome characterized by a diminished intestinal function that is inadequate to maintain normal digestion and absorption, leading to systemic metabolic disorder and requiring long-term nutritional supplementation to sustain health and growth. Short bowel syndrome (SBS) is one of the primary causes of intestinal failure. Given the significant differences among SBS patients, nutritional treatment strategies should emphasize individualization. This review focuses on SBS, combining its anatomical and pathological characteristics, to introduce nutritional support treatment plans and experiences for patients with intestinal failure.

    肠衰竭短肠综合征营养支持治疗

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    复杂肠瘘阶梯治疗及营养支持治疗策略

    戴典吟罗福文朱雯洁
    236-240页
    查看更多>>摘要：肠瘘是腹部外科的常见疾病和并发症之一，在引起严重腹腔感染的同时出现梗阻、出血、营养不良，并发展为复杂肠瘘，导致治疗难度增加、治疗费用增加、患者病死率高等。目前，肠瘘的治疗主要以阶梯式的三段治疗为主：（1）早期诊断；（2）中期营养支持治疗；（3）后期确定性手术治疗。营养支持治疗能显著降低患者病死率，提高治愈率。由于肠瘘治疗具有困难性、复杂性和多样性，且复杂肠瘘是目前肠瘘治疗中的难点，因此本文将分别介绍不同阶段的进展和难点，并从跨学科合作的角度展望肠瘘未来治疗的方向。 Intestinal fistula is one of the common diseases and complications in abdominal surgery. It does not only cause severe abdominal infections but also leads to obstruction, bleeding, malnutrition, and may develop into complex intestinal fistulas, resulting in increased challenges in treatment, elevated treatment costs, and increased risk of patient mortality. At present, the treatment of intestinal fistula mainly adopts a three-stage approach: (1) early diagnosis, (2) mid-term nutritional support treatment, and (3) definitive surgical treatment. Nutritional support treatment can significantly reduce patient mortality and improve recovery. Due to the difficulty, complexity, and diversity of intestinal fistula treatment, and the fact that complex intestinal fistulas are currently a challenge in the treatment of intestinal fistulas, this article will introduce the progress and difficulties at different stages, and explore the future treatment direction of intestinal fistulas from the perspective of interdisciplinary cooperation.

    肠瘘阶梯治疗营养支持治疗手术治疗

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    肠瘘合并严重腹腔感染患者早期肠内营养支持治疗的安全性评估

    谢天陈晨杨栋梁王文越...
    241-246页
    查看更多>>摘要：目的 评估肠瘘合并严重腹腔感染患者早期肠内营养支持治疗（EEN）的安全性。 方法 采用回顾性队列研究的方法。收集2017年1月1日至2020年1月1日期间，在上海交通大学医学院附属第九人民医院普通外科一科收治的204例肠瘘合并严重腹腔感染患者的临床资料。以入重症监护室（ICU）48 h内是否成功实施肠内营养支持治疗（EN），将患者分为EEN组和延迟EN（DEN）组。主要研究指标为180 d病死率；次要研究指标为腹腔出血、感染性休克、腹腔开放、血流感染、机械通气和连续性肾脏替代治疗（CRRT）事件发生率。采用logistic回归对死亡危险因素进行分析。 结果 两组患者在入ICU时血液学及人口学资料比较差异无统计学意义（均P>0.05）。但EEN组患者感染性休克［31.2%（15/48）比15.4%（24/156），χ2=4.99，P=0.025］、CRRT［27.1%（13/48）比9.0%（14/156），χ2=8.96，P=0.003］和180 d病死率［31.2%（15/48）比7.7%（12/156），χ2=15.75，P<0.001］比例显著高于DEN组患者（均P<0.05）。多因素回归分析显示，年龄越大（OR=1.082，95%CI：1.027~1.139，P=0.003）、急性生理学及慢性健康状况评分（APACHEⅡ评分）越差（OR=1.189，95%CI：1.037~1.363，P=0.013）、C反应蛋白水平越高（OR=1.013，95%CI：1.004~1.023，P=0.007）和EEN（OR=8.844，95%CI：1.809~43.240，P=0.007）为肠瘘合并严重腹腔感染患者死亡的独立危险因素。 结论 EEN可导致肠瘘合并严重腹腔感染患者的不良事件发生，增加死亡风险。此类患者的EEN需审慎实施。 Objective To evaluate the safety of early enteral nutrition (EEN) support in patients with severe intra-abdominal infection and intestinal fistulas. Methods This was a retrospective cohort study. We collected relevant clinical data of 204 patients with severe intra-abdominal infection and intestinal fistulas who had been managed in the No. 1 Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University between 1 January 2017 and 1 January 2020. The patients were allocated to EEN or delayed enteral nutrition (DEN) groups depending on whether enteral nutrition had been instituted within 48 hours of admission to the intensive care unit. The primary outcome was 180-day mortality. Other outcomes included rates of intraperitoneal hemorrhage, septic shock, open abdominal cavity, bloodstream infection, mechanical ventilation, and continuous renal replacement therapy. Risk factors for mortality were analyzed by logistic regression. Results There were no significant differences in hematological data or other baseline characteristics between the two groups at the time of admission to the intensive care unit (all P>0.05). However, septic shock (31.2% [15/48] vs. 15.4% [24/156], χ2=4.99, P=0.025), continuous renal replacement therapy (27.1% [13/48] versus 9.0% [14/156], χ2=8.96, P=0.003), and 180-day mortality (31.2% [15/48] vs. 7.7% [12/156], χ2=15.75, P<0.001) were significantly more frequent in the EEN than the DEN group (allP<0.05). Multivariate regression analysis showed that older age (OR=1.082, 95%CI:1.027-1.139,P=0.003), worse Acute Physiology and Chronic Health Evaluation (APACHE) II scores (OR=1.189, 95%CI: 1.037-1.363, P=0.013), higher C-reactive protein (OR=1.013, 95%CI:1.004-1.023, P=0.007) and EEN (OR=8.844, 95%CI:1.809- 43.240, P=0.007) were independent risk factors for death in patients with severe intra-abdominal infection and intestinal fistulas. Conclusion EEN may lead to adverse events and increase mortality in patients with both enterocutaneous fistulas and severe abdominal infection. EEN should be implemented with caution in such patients.

    肠瘘腹腔感染危重症医学营养治疗肠内营养支持治疗,早期

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    一项基于全国多中心前瞻性登记队列研究（PACAGE）的中国胃癌和结直肠癌患者术后并发症现状分析

    张书勤吴舟桥霍博文徐惠宁...
    247-260页
    查看更多>>摘要：目的 探讨我国胃癌和结直肠癌患者术后并发症的发生率，并评估其危险因素。 方法 本研究采用全国多中心前瞻性数据登记队列研究方法，数据来自中国胃肠肿瘤外科联盟发起的胃肠外科手术后腹部并发症现状研究数据库（PACAGE）。PACAGE数据库自2018年12月至2020年12月期间，前瞻性收集了20家医学中心胃癌和结直肠癌患者一般人口统计学数据、围手术期治疗及术后并发症相关数据，根据是否发生术后并发症进行分组，参照胃肠肿瘤外科术后并发症相关专家共识和Clavien-Dindo分级标准，对并发症进行分类及分级。通过绘制热图，将不同分级的术后并发症发生率可视化；采用多因素非条件logistic回归模型，分析发生术后并发症的独立危险因素。 结果 共纳入3 926例胃癌和结直肠癌患者，657例患者共发生876例次术后并发症，总体并发症发生率16.7%（657/3 926），Ⅲ级及以上严重并发症发生率4.0%（156/3 926），Ⅴ级并发症发生率0.2%（7/3 926）。胃癌患者2 271例，术后并发症发生率18.1%（412/2 271），严重并发症发生率4.7%（106/2 271）；结直肠癌患者1 655例，术后并发症发生率14.8%（245/1 655），严重并发症发生率3.0%（50/1 655）。胃癌和结直肠癌患者吻合口漏的发生率分别是3.3%（74/2 271）和3.4%（56/1 655）。腹腔感染在各类并发症中占比最高，在胃癌和结直肠癌患者中分别为28.7%（164/572）和39.5%（120/304）。在所有术后并发症严重程度分级中，Ⅱ级并发症占比最高，胃癌和结直肠癌分别占65.4%（374/572）和56.6%（172/304）。多因素分析显示：（1）胃癌组患者发生术后并发症的独立影响因素包括：有术前合并症（OR=2.54，95%CI：1.51~4.28，P<0.001）、接受新辅助治疗（OR=1.42，95%CI：1.06~1.89，P=0.020）、美国麻醉医师协会评分较高（ASA，2分：OR=1.60，95%CI：1.23~2.07，P<0.001；≥3分：OR=0.43，95%CI：0.25~0.73，P=0.002）、手术时间>180 min（OR=1.81，95%CI：1.42~2.31，P<0.001）、术中出血量>50 ml（OR=1.29，95%CI：1.01~1.63，P=0.038）和相比于全胃切除术的远端胃切除（OR=0.65，95%CI：0.51~0.83，P<0.001）；（2）肠癌组患者发生术后并发症的独立影响因素包括：女性（OR=0.60，95%CI：0.44~0.80，P<0.001）、有术前合并症（OR=2.73，95%CI：1.25~5.99，P=0.030）、接受新辅助治疗（OR=1.83，95%CI：1.23~2.72，P=0.008）、腹腔镜手术（OR=0.47，95%CI：0.30~0.72，P=0.022）和相比于低位前切术的腹会阴联合切术（OR=2.74，95%CI：1.71~4.41，P<0.001）。 结论 胃癌和结直肠癌患者术后各类感染相关的并发症最为常见，虽然两者术后发生并发症的危险因素各有不同，但有术前合并症、行新辅助治疗以及手术切除范围，是胃癌和结直肠癌患者术后发生并发症的共同影响因素。 Objective To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications. Methods This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression. Results The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271) and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89,P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73,P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63,P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001) and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80,P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99,P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

    胃肿瘤结直肠肿瘤术后并发症风险因素

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    腹腔镜近端胃切除后Kamikawa吻合术与双通道吻合术的近期疗效的倾向性评分匹配分析

    杨海成贺加星杨莹韩卓...
    261-267页
    查看更多>>摘要：目的 比较Kamikawa吻合术与双通道吻合（DTR）术在近端胃切除术后的近期疗效。 方法 本研究采用倾向性评分匹配研究方法和回顾性队列研究方法。病例纳入标准为年龄20~70岁；经术前内镜活检病理诊断为胃癌；肿瘤直径≤4 cm且位于胃上1/3（包括食管胃交界处）；TNM分期为ⅠA、ⅠB或ⅡA期。回顾性收集2020年6月至2023年2月期间在空军军医大学唐都医院胃肠外科行腹腔镜近端胃癌根治术的73例患者临床资料，其中行Kamikawa吻合术19例（Kamikawa组），行DTR术54例（DTR组）。使用R语言进行1∶2倾向性评分匹配患者的一般资料，最终Kamikawa组纳入17例，DTR组纳入34例。比较两组患者的手术相关情况、术后生活质量以及术后并发症等。 结果 倾向匹配后，两组基线资料差异无统计学意义（均P>0.05）。与DTR组相比较，Kamikawa组手术时间更长［（321.5±15.7）min比（296.8±26.1）min，t=32.056，P<0.001］、吻合时间更长［（93.0±6.8）min比（45.3±7.7）min，t=56.303，P<0.001］，而出血量较少［76（54~103）ml比112（82~148）ml，Z=71.536，P<0.001］，差异均有统计学意义。两组肿瘤大小、术后首次通气时间、术后住院时间、淋巴结清扫数量和清扫时间以及住院总费用的差异均未见统计学意义（均P>0.05）。中位随访时间（6.1±1.8）个月。在术后生活质量评价中，Kamikawa组较DTR组上消化道造影反流比率较低［0比29.4%（10/34），χ2=6.220，P=0.013］，差异有统计学意义；而两组在生活质量评分、随访3个月和6个月胃食管反流病（GERD）量表等方面差异均无统计学意义（均P>0.05）。Kamikawa组的术后并发症发生率为2/17，明显低于DTR组的41.2%（14/34），差异有统计学意义（χ2=4.554，P=0.033）。 结论 Kamikawa吻合和DTR均为理想的近端胃术后消化道重建方式。虽然Kamikawa吻合耗时略长，对手术团队要求更高，但术后抗反流效果可能更佳。 Objective To compare the short-term efficacy of Kamikawa anastomosis and double-tract reconstruction (DTR) after proximal gastrectomy. Methods This was a propensity score matched, retrospective, cohort study. Inclusion criteria comprised age 20–70 years, diagnosis of gastric cancer by pathological examination of preoperative endoscopic biopsies, tumor diameter ≤4 cm, and location in the upper 1/3 of the stomach (including the gastroesophageal junction), and TNM stage IA, IB, or IIA. The study cohort comprised 73 patients who had undergone laparoscopic proximal gastric cancer radical surgery in the Department of Gastroenterology, Tangdu Hospital, Air Force Medical University between June 2020 and February 2023, 19 of whom were in the Kamikawa group and 54 in the DTR group. After using R language to match the baseline characteristics of patients in a ratio of 1:2, there were 17 patients in the Kamikawa group and 34 in the DTR group. Surgery-related conditions, postoperative quality of life, and postoperative complications were compared between the two groups. Results After propensity score matching, there were no statistically significant differences in baseline data between the two groups (P>0.05). Compared with the DTR group, the Kamikawa group had longer operative times (321.5±15.7 minutes vs. 296.8±26.1 minutes,t=32.056, P<0.001), longer anastomosis times (93.0±6.8 minutes vs. 45.3±7.7 minutes,t=56.303, P<0.001), and less bleeding (76 [54~103] mL vs.112 [82~148) mL,Z=71.536, P<0.001) these differences are statistically significant. There were no statistically significant differences between the two groups in tumor size, time to first postoperative passage of gas, postoperative hospital stay, number of lymph nodes removed, duration of lymph node dissection, or total hospitalization cost (allP>0.05). The median follow-up time was 6.1 ± 1.8 months. As to postoperative quality of life, the Kamikawa group had a lower rate of upper gastrointestinal contrast reflux than did the DTR group (0 vs. 29.4% [10/34], χ2=6.220, P=0.013) this difference is statistically significant. However, differences between the two groups in quality of life score on follow-up of 3 months and 6 months on the Gastroesophageal Reflux Disease (GERD) scale were not statistically significant (all P>0.05). The incidence of postoperative complications was 2/17 in the Kamikawa group, which is significantly lower than the 41.2% (14/34) in the DTR group (χ2=4.554, P=0.033). Conclusion Kamikawa anastomosis and DTR are equally safe and effective procedures for reconstructing the digestive tract after proximal gastric surgery. Although Kamikawa anastomosis takes slightly longer and places higher demands on the surgical team, it is more effective at preventing postoperative reflux.

    胃肿瘤,近端消化道重建Kamikawa吻合术双通道吻合术

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    作者更正声明

    267页
    查看更多>>摘要：本刊2022年第25卷第9期第804页发表的《2018—2020年中国结直肠术后手术部位感染现状研究》一文，第804页摘要第22行中的“（3.5%，50/1 397）”，应修改为“（3.5%，50/1 447）”。第808页表3中的倒数第4行腹腔镜或机器人的例数“1 397（68.2）”，应修改为“1 447（68.2）”。
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