Linear stapler anastomosis for esophagogastrostomy in laparoscopic proximal gastrectomy reduce reflux esophagitis
Linear stapler anastomosis for esophagogastrostomy in laparoscopic proximal gastrectomy reduce reflux esophagitis
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DOI：
10.1007/s00423-021-02250-5
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发表时间：
2021-06-22
影响因子：
2.3
通讯作者：
Koyama, Isamu
中科院分区：
文献类型：
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作者：
Sugita, Hirofumi;Sakuramoto, Shinichi;Koyama, Isamu
目的腹腔镜近端胃切除术（LPG）的重建方法有多种，如食管胃吻合术（EG）、双通道重建术、空肠间置术等。我们从2013年开始使用环形吻合器（OrVil）进行EG，从2017年开始使用直线型吻合器进行EG。本回顾性研究旨在阐明哪种吻合器更适合EG和LPG。方法回顾性分析2013年1月至2019年9月间84例接受EG治疗的LPG患者的临床资料。45例患者（CS组）使用环形吻合器（OrVil）进行胃底折叠术，39例患者（LS组）使用直线型吻合器进行胃底折叠术。对患者的医疗记录进行了审查。在每次门诊咨询时通过访谈获得临床症状。所有患者均接受术后1年随访内镜检查。为了尽量减少两组之间的偏倚，使用逻辑回归模型计算倾向评分。在倾向评分匹配后，对60例患者（CS组30例，LS组30例）进行了研究。结果两组患者特征、手术效果相似。两组均有1例患者（3.3%）发生吻合口漏。CS组5例患者（16.7%）和LS组2例患者（6.7%）发生吻合口狭窄。LS组（3.4%）重度反流性食管炎（C级或D级）患者的发生率显著低于CS组（26.7%）（p = 0.026）。结论采用直线型吻合器行食管胃吻合术可降低重度反流性食管炎的发生率，是一种安全可行的吻合方法。
Purpose There are various reconstruction methods for Laparoscopic proximal gastrectomy (LPG), such as esophagogastrostomy (EG), double-tract reconstruction, and jejunal interposition. We have performed EG using a circular stapler (OrVil) from 2013 and using a linear stapler from 2017. The aim of this retrospective study was to clarify which stapler is better for EG for LPG. Methods The data of 84 patients who underwent EG for LPG between January 2013 and September 2019 were analyzed. EG with fundoplication was done using a circular stapler (OrVil) in 45 patients (CS group) and a linear stapler in 39 patients (LS group). The patients' medical records were reviewed. Clinical symptoms were obtained by interview at each outpatient consultation. All patients underwent postoperative 1-year follow-up endoscopy. To minimize bias between the two groups, propensity scores were calculated using a logistic regression model. After propensity-score matching, 60 patients (30 in the CS group and 30 in the LS group) were studied. Results Patient characteristics, operative outcomes were similar in two groups. Anastomotic leakage occurred in one patient (3.3%) in both groups. Anastomotic stenosis occurred in five patients (16.7%) in the CS group and two patients (6.7%) in the LS group. The rate of patients with severe reflux esophagitis (grade C or D) was significantly lower in the LS group (3.4%) than in the CS group (26.7%) (p = 0.026). Conclusions EG with a linear stapler could reduce the risk of severe reflux esophagitis, and it could be a safe and feasible anastomosis for patients after LPG.