| Objective:To investigate the safety,feasibility and short-term efficacy of total laparoscopy compared with laparoscopic assisted surgery for proximal gastrectomy with interposition jejunum.Method:A retrospective analysis was performed on 41 patients diagnosed with gastric cancer and treated with laparoscopic proximal gastrectomy and interposition jejunum in our hospital from January 2014 to December 2020.According to different surgical methods,the patients were divided into two groups: total laparoscopic proximal gastrectomy and interjejunal group(TL group),20 patients,and laparoscopic assisted proximal gastrectomy and interjejunal group(LA group),21 patients.The clinical data of the two groups were collected,and the clinical situation,during operation,after operation and follow-up data of the two groups were compared.Results:The operations of both groups were successfully completed.In the process of data collection,5 patients in the TL group were lost to follow-up,and data of 15 patients were finally obtained,while data of 21 patients in the LA group were collected.There were no significant differences in gender,age,BMI,underlying diseases,preoperative anesthesia grade,tumor differentiation and pathological stage between the two groups(P>0.05).The operative time of TL group(360.67±69.20)min was longer than that of LA group(264.29 ± 53.20)min(P<0.05).However,the incision length in TL group(4.13±1.35)cm was significantly shorter than that in LA group(10.05±1.91)cm.The time of first ambulation,first exhaust and first liquid diet in TL group were shorter than those in LA group(19.71 ± 2.33)h and(29.99±3.40)h,(2.47±1.46)d and(3.3 ± 0.97)d,respectively.(2.47±1.46)d and(5.43±1.39)d(P<0.05);The level of C-reactive protein in TL group was(47.40±13.89)mg/L on day 1,(74.33±20.17)mg/L in LA group and(82.87±38.88)mg/L on day 3 after operation.LA group was(118.46±22.55)mg/L(P<0.05);In addition,3 days after surgery,pain score in TL group was significantly lower than that in LA group(P<0.05).The number of dissected lymph nodes in TL group(26.27±7.82)was higher than that in LA group(17.52 ± 8.58)(P<0.05).There were no significant differences in intraoperative blood loss,tumor resection diameter,postoperative hospitalization days,hospitalization costs and postoperative complications between the two surgical methods(P >0.05).Anastomotic obstruction occurred in 1 case in THE TL group,intestinal obstruction occurred in 1 case,and anastomotic fistula occurred in 1 case in the LA group.All 3 patients recovered well after conservative treatment.No anastomotic bleeding or incision infection occurred in the two groups.There were no significant differences in RBC count,lymphocyte count,hematocrit and hemoglobin between the two groups before operation and 1 week,1month,3 months and 6 months after operation(P > 0.05).Albumin and total protein in LA group were higher than those in TL group before operation,with statistical significance but no clinical significance(P<0.05).There were no significant differences in albumin and total protein between the two groups at 1 week,1 month,3 months and 6 months after operation(P > 0.05).Conclusion:In this study,the safety,feasibility and short-term efficacy of complete laparoscopic proximal gastrectomy with interjejunum in the treatment of proximal gastric cancer were preliminarly confirmed.At the same time,complete laparoscopic proximal gastrectomy with jejunum interposition achieves less intraoperative injury,less postoperative pain for patients and freedom of speciman extraction approaches,and greatly improves postoperative abdominal aesthetics for patients. |
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