机器人与腹腔镜辅助近端胃切除联合双肌瓣吻合治疗早期胃上部癌的近期效果对比

doi:10.3969/j.issn.1674-8115.2025.07.009

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (7): 874-882.doi: 10.3969/j.issn.1674-8115.2025.07.009

机器人与腹腔镜辅助近端胃切除联合双肌瓣吻合治疗早期胃上部癌的近期效果对比

木尔扎特·艾麦提, 张业骞, 刘涛, 白龙, 张浩宇, 倪博, 关玉静, 王书昌, 顾佳毅, 朱纯超, 夏翔(), 张子臻()

上海交通大学医学院附属仁济医院胃肠外科，上海 200127

收稿日期:2024-11-03 接受日期:2025-02-21 出版日期:2025-07-28 发布日期:2025-07-21
通讯作者: 张子臻，主任医师，博士；电子信箱：zhangzizhen@renji.com。
夏　翔，主治医师，博士；电子信箱：xiaxiang@renji.com。
基金资助:
国家自然科学基金(82173215);上海市“医苑新星”青年医学人才培养资助计划(2022-65);上海市卫生健康委员会卫生行业临床研究专项(202140458);上海市自然科学基金(22ZR1438800);上海交通大学医学院附属仁济医院培育基金项目(RJTJ22-MS-025)

A comparative analysis of the short-term efficacy of robotic and laparoscopic proximal gastrectomy combined with double-flap anastomosis in the treatment of early upper gastric cancer

AIMAITI Muerzhate, ZHANG Yeqian, LIU Tao, BAI Long, ZHANG Haoyu, NI Bo, GUAN Yujing, WANG Shuchang, GU Jiayi, ZHU Chunchao, XIA Xiang(), ZHANG Zizhen()

Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Received:2024-11-03 Accepted:2025-02-21 Online:2025-07-28 Published:2025-07-21
Contact: ZHANG Zizhen, E-mail: zhangzizhen@renji.com.
XIA Xiang, E-mail: xiaxiang@renji.com.
Supported by:
National Natural Science Foundation of China(82173215);Shanghai “Medical Rising Stars” Youth Medical Talent Cultivation and Funding Program(2022-65);Shanghai Health Commission Clinical Research Special Fund(202140458);Shanghai Natural Science Foundation(22ZR1438800);Incubation Fund of Renji Hospital, Shanghai Jiao Tong University School of Medicine(RJTJ22-MS-025)

摘要/Abstract

摘要：

目的·比较分析机器人与腹腔镜辅助近端胃切除联合双肌瓣吻合术在治疗早期胃上部癌中的安全性及近期效果。方法·采用回顾性队列研究方法，分析2023年9月至2024年3月于上海交通大学医学院附属仁济医院胃肠外科行近端胃切除联合双肌瓣吻合进行消化道重建的31例早期胃癌患者临床病理资料。根据手术方式不同，将患者分为机器人辅助手术组（机器人组，20例）和腹腔镜辅助手术组（腹腔镜组，11例）。比较2组患者的一般临床资料、术中情况及术后恢复情况。术后6个月随访时，行上消化道造影和食管胃镜检查，判断是否有吻合口狭窄及反流性食管炎；同时，使用欧洲癌症研究与治疗组织（European Organization for Research and Treatment of Cancer，EORTC）的胃癌特异模块量表（Quality of Life Questionnaire-Stomach 22，QLQ-STO22）评估患者的生活质量。结果·2组患者的一般资料，包括性别、年龄、术前合并症、美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级、Siewert分型以及肿瘤的病理分期，差异均无统计学意义（均P>0.05）。2组患者均顺利完成手术，无中转开腹。机器人组的胃食管吻合时间较腹腔镜组显著缩短［（31.09±8.23）min vs （43.73±8.83）min，P<0.001］，而术中及术后各项指标，包括手术时间、术中失血量、淋巴结清扫数、术后胃管留置时间、术后流质饮食开始时间、术后住院天数以及术后并发症发生率在2组之间差异均无统计学意义（均P>0.05）。术后6个月随访共有30例患者完成（其中机器人组失访1例）。上消化道造影及食管胃镜检查结果显示，仅腹腔镜组1例患者出现吻合口狭窄，机器人组出现A级和B级反流性食管炎各1例，腹腔镜组出现B级反流性食管炎1例。2组反流性食管炎和吻合口狭窄发生率差异均无统计学意义（均P>0.05）。EORTC QLQ-STO22评分结果显示，机器人组在吞咽困难、胃食管反流、饮食受限3个维度的评分，以及量表总分均显著低于腹腔镜组（均P<0.05）。结论·机器人辅助近端胃切除联合双肌瓣吻合手术安全可行，术中吻合时间更短，且在术后功能恢复和患者生活质量提升方面具有潜在优势。

关键词: 机器人手术, 近端胃切除, 双肌瓣吻合, 胃上部肿瘤

Abstract:

Objective ·To compare the safety and short-term outcomes of robot-assisted versus laparoscopic-assisted proximal gastrectomy combined with double-flap esophagogastrostomy in the treatment of early upper gastric cancer. Methods ·A retrospective cohort study was conducted to analyze the clinical and pathological data of 31 early gastric cancer patients who underwent proximal gastrectomy combined with double-flap esophagogastrostomy for gastrointestinal reconstruction at the Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, from September 2023 to March 2024. Based on the surgical approach, patients were divided into the robot-assisted surgery group (robotic group, 20 cases) and the laparoscope-assisted surgery group (laparoscopic group, 11 cases). General clinical data, intraoperative conditions, and postoperative recovery between the two groups were compared. At the 6-month postoperative follow-up, upper gastrointestinal radiography and esophagogastroscopy were performed to assess anastomotic stricture and gastroesophageal reflux disease. Additionally, the gastric cancer-specific module of the European Organization for Research and Treatment of Cancer (EORTC), Quality of Life Questionnaire-Stomach 22 (QLQ-STO22), was used to evaluate the patients′ quality of life. Results ·The general data of the two groups, including gender, age, preoperative comorbidities, American Society of Anesthesiologists (ASA) classification, Siewert classification, and pathological staging of tumors, showed no statistically significant differences (all P>0.05). All patients successfully underwent the procedure without conversion to open surgery. The time for gastroesophageal anastomosis was significantly shorter in the robotic group compared to the laparoscopic group [(31.09±8.23) min vs (43.73±8.83) min, P<0.001], while there were no statistically significant differences in other intraoperative and postoperative parameters, including operative time, intraoperative blood loss, number of lymph nodes removed, duration of gastric tube placement, time to start a liquid diet, length of postoperative hospital stay, and incidence of postoperative complications (all P>0.05). At the 6-month postoperative follow-up, 30 patients completed the follow-up, with one patient lost to follow-up in the robotic group. Upper gastrointestinal radiography and esophagogastroscopy results showed that only one patient in the laparoscopic group developed an anastomotic stricture, while one patient in the robotic group developed grade A and one developed grade B gastroesophageal reflux disease (GERD). In addition, one patient in the laparoscopic group also developed grade B GERD. The incidences of GERD and anastomotic stricture showed no statistically significant differences between the two groups (both P>0.05). EORTC QLQ-STO22 results indicated that the robotic group had significantly lower scores in the dimensions of dysphagia, gastroesophageal reflux, and dietary restrictions, as well as in the total score, compared to the laparoscopic group (all P<0.05). Conclusion ·Robot-assisted proximal gastrectomy combined with double-flap esophagogastrostomy is safe and feasible. It shortens anastomosis time and offers potential advantages in postoperative functional recovery and quality of life improvement.

Key words: robotic surgery, proximal gastrectomy, double-flap anastomosis, upper gastric cancer

中图分类号:

R656.6

木尔扎特·艾麦提, 张业骞, 刘涛, 白龙, 张浩宇, 倪博, 关玉静, 王书昌, 顾佳毅, 朱纯超, 夏翔, 张子臻. 机器人与腹腔镜辅助近端胃切除联合双肌瓣吻合治疗早期胃上部癌的近期效果对比[J]. 上海交通大学学报（医学版）, 2025, 45(7): 874-882.

AIMAITI Muerzhate, ZHANG Yeqian, LIU Tao, BAI Long, ZHANG Haoyu, NI Bo, GUAN Yujing, WANG Shuchang, GU Jiayi, ZHU Chunchao, XIA Xiang, ZHANG Zizhen. A comparative analysis of the short-term efficacy of robotic and laparoscopic proximal gastrectomy combined with double-flap anastomosis in the treatment of early upper gastric cancer[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(7): 874-882.

图/表 7

图1 机器人近端胃切除联合双肌瓣吻合术戳孔布局Note： R1—placement of the Da Vinci ultrasonic scalpel; R2—the observation port; R3—placement of bipolar electrocoagulation; R4—the assistant′s auxiliary operating port; R5—the assistant′s auxiliary operating port.

Fig 1 Trocar placement in the robotic proximal gastrectomy combined with double-flap anastomosis

图2 近端胃根治性切除联合双肌瓣吻合术操作步骤截图Note： A. Transecting the gastrocolic ligament 3 cm below the arch to expose the left gastroepiploic vessels. B. Ligating and dividing the left gastroepiploic vessels to complete the lymph node dissection of subgroup No. 4sb. C. Ligating and dividing the short gastric vessels, followed by exposure and mobilization of the left side of the esophagus. D. Lymph node dissection of groups No.7, No.8, and No.9. E. Adequate mobilization of the lower end of the esophagus. F. Constructing the gastric remnant. G. Creating double muscular flaps. H. Continuous seromuscular suturing of the posterior wall of the esophagus to the gastric remnant. I. Continuous suturing of the esophageal stump to the gastric remnant. J. Interrupted Y-shaped suturing of the double muscular flaps.

Fig 2 Screenshots of the operative steps for proximal gastrectomy combined with double-flap anastomosis

表1 机器人组和腹腔镜组胃癌患者临床资料比较

Tab 1 Comparison of clinical information between the robotic group and the laparoscopic group of gastric cancer patients

Index	Robotic group (n=20)	Laparoscopic group (n=11)	P value
Gender/n(%)			0.319
Male	16 (80.0)	7 (63.6)
Female	4 (20.0)	4 (36.4)
Age/year	53.20±3.89	54.00±6.28	0.663
BMI/(kg·m^-2)	22.35±1.69	22.86±2.52	0.502
Comorbidity/n(%)			0.283
Yes	5 (25.0)	1 (9.1)
No	15 (75.0)	10 (90.9)
ASA classification/n(%)			0.643
Ⅰ	16 (80.0)	8 (72.7)
Ⅱ	4 (20.0)	3 (27.3)
Siewert classification/n(%)			0.842
Ⅱ	8 (40.0)	4 (36.4)
Ⅲ	12 (60.0)	7 (63.6)
Pathological stage/n(%)			0.887
ⅠA	12 (60.0)	7 (63.6)
ⅠB	8 (40.0)	4 (36.4)

表2 机器人组和腹腔镜组术中及术后各项指标的比较

Tab 2 Comparison of intraoperative and postoperative indicators between the robotic group and the laparoscopic group

Index	Robotic group (n=20)	Laparoscopic group (n=11)	P value
Operative time/min	244.92±34.05	258.82±63.43	0.431
Esophagogastric anastomosis time/min	31.09±8.23	43.73±8.83	<0.001
Intraoperative blood loss/mL	40.10±11.17	49.91±23.27	0.122
Lymph nodes harvested/n	29±3	28±6	0.725
Postoperative nasogastric tube duration/d	2.0±0.2	2.0±0.7	0.851
Time to start liquid diet/d	3 (2, 4)	3 (3, 4)	0.403
Postoperative hospital stay/d	7 (6, 7)	7 (7, 7)	0.056
Postoperative complication/n(%)			0.818
Yes	3 (15.0)	2 (18.2)
No	17 (85.0)	9 (81.8)
Postoperative reflux esophagitis^①/n(%)	2 (10.5)	1 (9.1)	0.900
Postoperative anastomotic stricture^①/n(%)	0 (0)	1 (9.1)	0.181

图3 机器人组和腹腔镜组患者术后6个月上消化道造影图像Note： A. A typical image of a patient in the robotic group without anastomotic stricture. B. An image of the only patient with anastomotic stricture in the laparoscopic group.

Fig 3 Upper gastrointestinal contrast images of patients in the robotic group and the laparoscopic group 6 months after operation

图4 机器人组和腹腔镜组患者术后6个月食管胃镜检查图像Note： A. The patient with grade A reflux esophagitis in the robotic group. B. The patient with grade B reflux esophagitis in the robotic group. C. The patient with grade B reflux esophagitis in the laparoscopic group. D. The patient with postoperative anastomotic stricture in the laparoscopic group.

Fig 4 Endoscopic images of patients in the robotic group and the laparoscopic group 6 months after operation

表3 EORTC QLQ-STO22评估机器人组和腹腔镜组患者术后6个月生活质量情况

Tab 3 Quality of life of patients in the robotic and laparoscopic groups assessed by EORTC QLQ-STO22 at 6 months postoperatively

QLQ-STO22	Robotic group (n=19)	Laparoscopic group (n=11)	P value
Total score/score	23.89±3.13	27.09±3.62	0.017
Dysphagia/score	3 (3~3)	4 (3~5)	0.026
Epigastric pain/score	5 (4~6)	6 (5~7)	0.123
Reflux/score	3 (3~4)	5 (5~5)	0.027
Dietary restrictions/score	3 (3~3)	4 (3~4)	0.017
Anxiety/score	4 (3~4)	4 (3~4)	0.703
Dry mouth/score	1 (1~1)	1 (1~2)	0.611
Taste problems/score	1 (1~1)	1 (1~1)	0.735
Body image concerns/score	1 (1~2)	1 (1~2)	0.832
Hair loss/score	1 (1~1)	1 (1~1)	0.471

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机器人与腹腔镜辅助近端胃切除联合双肌瓣吻合治疗早期胃上部癌的近期效果对比

A comparative analysis of the short-term efficacy of robotic and laparoscopic proximal gastrectomy combined with double-flap anastomosis in the treatment of early upper gastric cancer

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