腹腔镜全胃切除术后 Roux-en-Y 重建中口袋对老年患者的影响

Juntendo Iji Zasshi Pub Date : 2024-05-24 eCollection Date: 2024-01-01 DOI:10.14789/jmj.JMJ23-0036-OA
Akira Kubota, Suguru Yamauchi, Yutaro Yoshimoto, Kenki Tsuda, Yukinori Yube, Sanae Kaji, Hajime Orita, Malcolm V Brock, Tetsu Fukunaga
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引用次数: 0

摘要

目的:患胃癌的老年人越来越多,因此需要微创手术治疗。老年患者有多种并发症,术后容易出现体重减轻、营养失调、胃切除术后综合征(PGS)和生活质量下降(QOL)。全胃切除术尤其容易引起这些并发症,尽管有报道称口袋的创建可以通过补偿失去的储胃能力来改善这种状况。然而,关于其重要性还没有达成共识。本研究旨在调查口唇袋对老年患者全胃切除术结果的影响:回顾性分析了符合资格标准的 36 例患者,即年龄≥75 岁的老年患者。这些患者于2016年7月至2022年6月在顺天堂大学进行的腹腔镜全胃切除术中接受了带口袋的Roux-en-Y重建术。主要结果为术后营养状况、PGS和QOL:14名老年患者和22名非老年患者的平均术后时间约为1年(12.0个月 vs. 13.5个月,P=0.536)。老年患者合并症较多(78.5% 对 40.9%,P=0.041)。营养状况结果显示,体重减轻率(-5.3% 对 -8.6%,P=0.651)和预后营养状况(-7.9% 对 -5.9%,P=0.243)无差异。老年患者和非老年患者在PGS和QOL方面没有明显差异:结论:从术后营养状况、PGS 和 QOL 的角度来看,43 例老年患者接受全胃切除术并创建口袋可能是有益的。
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Impact of the Aboral Pouch in Roux-en-Y Reconstruction after Laparoscopic Total Gastrectomy for Elderly Patients.

Objectives: The number of elderly people with stomach cancer is increasing; therefore, minimally invasive surgical treatments are required. Elderly patients have multiple comorbidities and are prone to postoperative weight loss, nutritional disorders, Postgastrectomy syndrome (PGS), and decreased quality of life (QOL). Total gastrectomy is particularly associated with these complications, although aboral-pouch creation reportedly improves the condition by compensating for lost reservoir capacity. However, there is no consensus regarding its significance. This study aimed to investigate the impact of the aboral pouch on total gastrectomy outcomes in elderly patients.

Materials and methods: Thirty-six patients who met the eligibility criteria, defined as elderly patients aged ≥75 years, were retrospectively analyzed. The patients had undergone Roux-en-Y reconstructions with an aboral pouch in laparoscopic total gastrectomy procedures performed at Juntendo University from July 2016 to June 2022. The main outcomes were postoperative nutritional status, PGS, and QOL.

Results: The average postoperative period was approximately 1 year (12.0 vs. 13.5 months, P=0.536), for 14 elderly and 22 non-elderly patients, respectively. Elderly patients had more comorbidities (78.5% vs. 40.9%, P=0.041). The outcome of nutritional status demonstrated no differences in weight-loss rate (-5.3% vs. -8.6%, P=0.651) or prognostic nutritional status (-7.9% vs. -5.9%, P=0.243). There was no significant difference in PGS and QOL between elderly and non-elderly patients.

Conclusions: Total gastrectomy with an aboral-pouch creation could be beneficial for elderly 43 patients from the perspective of postoperative nutritional status, PGS, and QOL.

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