锥形管状胃与常规管状胃在双镜同步食管癌根治术中近期临床疗效对比：一项倾向性评分匹配的回顾性队列研究

龙谦; 孙香; 赵祖源; 朱紫茵; 姚舒桓; 韦海涛; 李丽; 李霞鹏

doi:10.16016/j.2097-0927.202604104

您当前的位置：

首页 >

文章列表页 >

锥形管状胃与常规管状胃在双镜同步食管癌根治术中近期临床疗效对比：一项倾向性评分匹配的回顾性队列研究

临床医学 | 更新时间：2026-09-16

- 锥形管状胃与常规管状胃在双镜同步食管癌根治术中近期临床疗效对比：一项倾向性评分匹配的回顾性队列研究
- Short-term clinical efficacy between coniform and conventional gastric tube in inflatable mediastinoscopy combined with laparoscopic esophagectomy: a propensity score-matched retrospective cohort study
- 陆军军医大学学报 2026年48卷第17期页码：2485-2493
- 作者机构：
  
  1.贵州省人民医院胸外科，贵州贵阳
  2.河南大学护理与健康学院慢病研究所，河南开封
  3.成都医学院临床医学院，四川成都
  4.河南大学淮河医院胸外科，河南开封
- 作者简介：
  
  李丽，E-mail：10210051@vip.henu.edu.cn
  李霞鹏，E-mail：258096@henu.edu.cn
- 基金信息：
  
  河南省科技厅科技攻关资助项目(262102310195);河南省高等学校重点科研项目(26A320002)
- DOI：10.16016/j.2097-0927.202604104
  中图分类号： R181.23;R730.56;R735.1
- 收稿：2026-04-29，
  
  修回：2026-07-29，
  
  录用：2026-07-30，
  
  纸质出版：2026-09-15
- 稿件说明：
移动端阅览
龙谦，孙香，赵祖源，等.锥形管状胃与常规管状胃在双镜同步食管癌根治术中近期临床疗效对比：一项倾向性评分匹配的回顾性队列研究［J］.陆军军医大学学报，2026，48（17）：2485-2493.DOI：10.16016/j.2097-0927.202604104.

Long Q，Sun X，Zhao Z Y，et al.Short-term clinical efficacy between coniform and conventional gastric tube in inflatable mediastinoscopy combined with laparoscopic esophagectomy： a propensity score-matched retrospective cohort study［J］.J Army Med Univ，2026，48（17）：2485-2493.DOI：10.16016/j.2097-0927.202604104.
龙谦，孙香，赵祖源，等.锥形管状胃与常规管状胃在双镜同步食管癌根治术中近期临床疗效对比：一项倾向性评分匹配的回顾性队列研究［J］.陆军军医大学学报，2026，48（17）：2485-2493.DOI：10.16016/j.2097-0927.202604104. DOI：

Long Q，Sun X，Zhao Z Y，et al.Short-term clinical efficacy between coniform and conventional gastric tube in inflatable mediastinoscopy combined with laparoscopic esophagectomy： a propensity score-matched retrospective cohort study［J］.J Army Med Univ，2026，48（17）：2485-2493.DOI：10.16016/j.2097-0927.202604104. DOI：

摘要

目的

食管癌是我国高发消化道恶性肿瘤，外科手术是其主要根治手段。充气式纵隔镜同步腹腔镜食管癌根治术逐步应用于食管癌外科治疗，消化道重建的胃塑形方式直接影响术后恢复与并发症发生，常规管状胃仍存在胸胃扩张、反流等问题，而锥形管状胃在此术式中的优劣尚不明确。本研究旨在比较常规管状胃和锥形管状胃在充气式纵隔镜同步腹腔镜食管癌根治术中的临床应用效果。

方法

采用单中心回顾性队列研究设计，纳入2023年1月至2025年1月在河南大学淮河医院胸外科行充气式纵隔镜同步腹腔镜食管癌根治术的患者共139例，根据临床实践中不同消化道重建方式分为常规管状胃组（77例）和锥形管状胃组（62例），所有患者均采用手工分层吻合，使用倾向性评分匹配（propensity score matching，PSM）对患者进行1∶1匹配。首要主要结局指标为术后并发症发生率，次要主要结局指标为术后主客观营养指标，次要结局指标包括炎症因子、胃肠功能指标及生活质量。

结果

经PSM匹配后，2组各纳入55例，匹配后患者基线资料比较，差异均无统计学意义（

0.05）。锥形管状胃组术后首次排气时间［（1.16±0.96）

（1.58±1.20）d，

=0.045］、首次经口进食时间［（4.43±2.10）

（5.48±2.98）d，

=0.035］显著短于常规管状胃组。锥形管状胃组胃食管反流（

=0.015）、胸胃扩张（

=0.026）发生率显著低于常规管状胃组，2组吻合口瘘、吻合口狭窄发生率无显著差异（均

0.05）。术后6个月随访提示，锥形管状胃组营养恢复更优，PG-

SGA评分显著更低（2.41±1.03

2.93±1.29，

=0.021），血清总蛋白、白蛋白、前白蛋白、血红蛋白等客观营养指标亦显著优于常规管状胃组（均

0.05）。次要结局指标中，术后1周锥形管状胃组炎症反应更轻微，IL-10［（7.85±0.61）

（8.47±0.65）ng/L，

0.001］、IL-6［（21.37±4.72）

（26.10±3.52）ng/L，

0.001］、TNF-α［（14.18±2.94）

（19.12±3.23）ng/L，

0.001］水平显著低于常规管状胃组。术后2周锥形管状胃组胃肠功能恢复更佳，MTL［（117.85±16.61）

（110.49±16.76）ng/L，

=0.023］、GAS［（62.58±15.72）

（55.12±16.11）ng/L，

=0.016］水平更高，术后6个月生活质量评估显示，锥形管状胃组生活质量评分显著更高（75.38±7.16

70.53±7.24，

0.05）。

结论

在充气式纵隔镜同步腹腔镜食管癌根治术中，相较于常规管状胃，锥形管状胃可显著改善患者术后胃肠功能，降低胸胃扩张、胃食管反流等并发症发生风险，改善术后营养状态并提升近期生活质量，具有临床应用价值。

Abstract

Objective

Esophageal cancer

a highly prevalent gastrointestinal malignancy in China

is primarily treated by surgical resection. Inflatable mediastinoscopy combined with laparoscopic esophagectomy has been gradually adopted in the surgical treatment for esophageal cancer. The gastric‑shaping strategy for digestive tract reconstruction directly affects postoperative recovery and complication occurrence. Conventional gastric tube reconstruction is still associated with problems such as intrathoracic gastric dilatation and gastroesophageal reflux

whereas the advantages and disadvantages of the coniform gastric tube in this surgical procedure remain unclear. This study aims to compare the clinical outcomes between conventional gastric tube and coniform gastric tube reconstruction after inflatable mediastinoscopy combined with laparoscopic esophagectomy.

Methods

A single-center retrospective cohort study was conducted on 139 patients who underwent inflatable mediastinoscopy combined with laparoscopic esophagectomy in Department of Thoracic Surgery of

Huaihe Hospital of Henan University between January 2023 and January 2025. According to different digestive tract reconstruction strategies

the patients were divided into a conventional gastric tube group (

=77) and a coniform gastric tube group (

=62). All patients received hand-sewn anastomosis. Propensity‑score matching (PSM) was performed at a 1∶1 ratio. The primary outcome was the incidence of postoperative complications

the secondary outcome was postoperative subjective and objective nutritional indicators

and secondary outcomes included inflammatory factors

gastrointestinal function indicators

and quality of life.

Results

After PSM

55 patients were included in each group

with no statistically significant differences in baseline characteristics between groups (all

0.05). The coniform gastric tube group demonstrated significantly shorter time to first postoperative flatus [(1.16±0.96)

(1.58±1.20) d

=0.045

]

and time to first oral intake [(4.43±2.10)

(5.48±2.98) d

=0.035

]

than the conventional gastric tube group. The incidences of gastroesophageal reflux (

=0.015) and intrathoracic gastric dilatation (

=0.026) were markedly lower in the coniform gastric tube group

whereas no significant intergroup differences were observed in the incidences of anastomotic leakage or anastomotic stricture (

0.05). At 6‑month postoperative follow‑up

better nutritional recovery was observed in the coniform gastric tube group

with significantly lower Patient-Generated Subjective Global Assessment (PG-SGA) scores (2.41±1.03

2.93±1.29

=0.021)

and objective nutritional indicators including serum total protein

albumin

prealbumin and hemoglobin were also significantly better than the conventional gastric tube group (all

0.05). For the secondary o

utcomes

the coniform gastric tube group exhibited milder inflammatory responses at 1 week postoperatively

with significantly lower levels of IL-10 [(7.85±0.61)

(8.47±0.65) ng/L

0.001

]

IL-6 [(21.37±4.72)

(26.10±3.52) ng/L

0.001

]

and TNF-α [(14.18±2.94)

(19.12±3.23) ng/L

0.001

]

. At 2 weeks postoperatively

gastrointestinal function recovery was obviously better in the coniform gastric tube group

with higher levels of motilin (MTL) [(117.85±16.61)

(110.49±16.76) ng/L

=0.023

]

and gastrin (GAS) [(62.58±15.72)

(55.12±16.11) ng/L

=0.016

]

. Quality of life assessment at 6 months postoperatively showed significantly higher scores in the coniform gastric tube group (75.38±7.16

70.53±7.24

0.05).

Conclusion

For patients undergoing inflatable mediastinoscopy combined with laparoscopic esophagectomy

coniform gastric tube reconstruction can effectively improve postoperative gastrointestinal function

reduce the risks of intrathoracic gastric dilatation and gastroesophageal reflux

promote postoperative nutritional status and enhance short‑term quality of life

demonstrating clinical application value.

关键词

Keywords

references

Bray F ， Laversanne M ， Sung H ， et al . Global cancer statistics 2022： GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries ［J］. CA Cancer J Clin ， 2024 ， 74 （ 3 ）： 229 - 263 . DOI： 10.3322/caac.21834 http://dx.doi.org/10.3322/caac.21834 .

陈金城，张小勤，刘杰，等 . 基于机器学习算法构建胸段食管鳞癌患者化疗联合免疫治疗反应预测模型的研究［J］. 陆军军医大学学报， 2025 ， 47 （ 6 ）： 591 - 601 . DOI： 10.16016/j.2097-0927.202412113 http://dx.doi.org/10.16016/j.2097-0927.202412113 .

Chen J C ， Zhang X Q ， Liu J ， et al . Development of a prediction model for chemotherapy and immunotherapy response in esophageal squamous cell carcinoma patients using machine learning algorithms ［J］. J Army Med Univ ， 2025 ， 47 （ 6 ）： 591 - 601 . DOI： 10.16016/j.2097-0927.202412113 http://dx.doi.org/10.16016/j.2097-0927.202412113 .

Shemmeri E ， Wee J O . Minimally invasive modified McKeown esophagectomy ［J］. Surg Oncol Clin N Am ， 2024 ， 33 （ 3 ）： 509 - 517 . DOI： 10.1016/j.soc.2023.12.020 http://dx.doi.org/10.1016/j.soc.2023.12.020 .

Wang J C ， Zhao L X ， Lin J ， et al . Comparison of mediastinoscopy and thoracoscope minimally invasive esophagectomy in the treatment of esophageal cancer： a meta-analysis and system review ［J］. BMC Cancer ， 2025 ， 25 （ 1 ）： 14 . DOI： 10.1186/s12885-024-13307-1 http://dx.doi.org/10.1186/s12885-024-13307-1 .

Xing H J ， Hu M Y ， Wang Z Q ， et al . Short-term outcomes of Ivor Lewis vs . McKeown esophagectomy： a meta-analysis ［J］. Front Surg ， 2022 ， 9 ： 950108 . DOI： 10.3389/fsurg. 2022. 950108 http://dx.doi.org/10.3389/fsurg.2022.950108 .

Fujiwara H ， Shiozaki A ， Konishi H ， et al . Single-port mediastinoscopic lymphadenectomy along the left recurrent laryngeal nerve ［J］. Ann Thorac Surg ， 2015 ， 100 （ 3 ）： 1115 - 1117 . DOI： 10.1016/j.athoracsur.2015.03.122 http://dx.doi.org/10.1016/j.athoracsur.2015.03.122 .

Fujiwara H ， Shiozaki A ， Konishi H ， et al . Hand-assisted laparoscopic transhiatal esophagectomy with a systematic procedure for en bloc infracarinal lymph node dissection ［J］. Dis Esophagus ， 2016 ， 29 （ 2 ）： 131 - 138 . DOI： 10.1111/dote.12303 http://dx.doi.org/10.1111/dote.12303 .

Ishii ， Tsubosa ， Mayanagi ， et al . Tissue oxygen saturation during gastric tube reconstruction with cervical anastomosis for esophagectomy： a case series ［J］. J Investig Surg ， 2022 ， 35 （ 4 ）： 809 - 813 . DOI： 10.1080/08941939.2021.1968080 http://dx.doi.org/10.1080/08941939.2021.1968080 .

Zhang X Q ， Zhang C F ， Zhou X J ， et al . Evaluation of anastomotic blood supply during digestive tract reconstruction with the use of the oxygen saturation index： a pooling up analysis ［J］. Int J Colorectal Dis ， 2025 ， 40 （ 1 ）： 71 . DOI： 10.1007/s00384-025-04864-3 http://dx.doi.org/10.1007/s00384-025-04864-3 .

肖鑫，栾思源，杨玉赏，等 . 锥形管状胃联合颈部端端分层吻合在胸腹腔镜食管癌切除术中的应用价值［J］. 中华消化外科杂志， 2019 ， 18 （ 6 ）： 542 - 548 . DOI： 10.3760/cma.j.issn.1673-9752.2019.06.007 http://dx.doi.org/10.3760/cma.j.issn.1673-9752.2019.06.007 .

Xiao X ， Luan S Y ， Yang Y S ， et al . Application value of cone-shaped gastric tube combined with cervical end-to-end anastomosis in thoracoscopic and laparoscopic esophagectomy for esophageal cancer ［J］. Chin J Dig Surg ， 2019 ， 18 （ 6 ）： 542 - 548 . DOI： 10.3760/cma.j.issn.1673-9752.2019.06.007 http://dx.doi.org/10.3760/cma.j.issn.1673-9752.2019.06.007 .

Low D E ， Alderson D ， Cecconello I ， et al . International consensus on standardization of data collection for complications associated with esophagectomy： esophagectomy complications consensus group （ECCG）［J］. Ann Surg ， 2015 ， 262 （ 2 ）： 286 - 294 . DOI： 10.1097/SLA. 0000000000001098 http://dx.doi.org/10.1097/SLA.0000000000001098 .

Bauer J ， Capra S ， Ferguson M . Use of the scored Patient-Generated Subjective Global Assessment （PG-SGA） as a nutrition assessment tool in patients with cancer ［J］. Eur J Clin Nutr ， 2002 ， 56 （ 8 ）： 779 - 785 . DOI： 10.1038/sj.ejcn.1601412 http://dx.doi.org/10.1038/sj.ejcn.1601412 .

Fayers P ， Bottomley A . Quality of life research within the EORTC： the EORTC QLQ-C30 ［J］. Eur J Cancer ， 2002 ， 38 ： 125 - 133 . DOI： 10.1016/s0959-8049（01）00448-8 http://dx.doi.org/10.1016/s0959-8049（01）00448-8 .

辛文彬，白倩，倪向敏，等 . 复方营养制剂干预对心血管外科手术患者临床预后影响的随机对照研究［J］. 陆军军医大学学报， 2025 ， 47 （ 24 ）： 3089 - 3101 . DOI： 10.16016/j.2097-0927.202510016 http://dx.doi.org/10.16016/j.2097-0927.202510016 .

Xin W B ， Bai Q ， Ni X M ， et al . Impact of compound nutritional preparations on clinical prognosis of patients undergoing cardiovascular surgery： a randomized controlled study ［J］. J Army Med Univ ， 2025 ， 47 （ 24 ）： 3089 - 3101 . DOI： 10.16016/j.2097-0927.202510016 http://dx.doi.org/10.16016/j.2097-0927.202510016 .

曾江，刘辉，彭海英 . 糖尿病合并肺结核患者淋巴细胞计数比值与血清炎症指标的相关性［J］. 中国老年学杂志， 2024 ， 44 （ 8 ）： 1831 - 1834 . DOI： 10.3969/j.issn.1005-9202.2024.08.012 http://dx.doi.org/10.3969/j.issn.1005-9202.2024.08.012 .

Zeng J ， Liu H ， Peng H Y . The correlation between lymphocyte count ratios and serum inflammatory indicators in patients with diabetes mellitus complicated with pulmonary tuberculosis ［J］. Chin J Gerontol ， 2024 ， 44 （ 8 ）： 1831 - 1834 . DOI： 10.3969/j.issn.1005-9202.2024.08.012 http://dx.doi.org/10.3969/j.issn.1005-9202.2024.08.012 .

Tack J ， Deloose E ， Ang D ， et al . Motilin-induced gastric contractions signal hunger in man ［J］. Gut ， 2016 ， 65 （ 2 ）： 214 - 224 . DOI： 10.1136/gutjnl-2014-308472 http://dx.doi.org/10.1136/gutjnl-2014-308472 .

Cheng Y F ， Tian Z ， Zhou J J ， et al . Evaluation of combined tubular gastroesophageal anastomosis and C-shaped flap technique in proximal gastrectomy for gastric cancer： a retrospective propensity score matching analysis ［J］. Eur J Surg Oncol ， 2025 ， 51 （ 9 ）： 110227 . DOI： 10.1016/j.ejso.2025.110227 http://dx.doi.org/10.1016/j.ejso.2025.110227 .

肖鑫 . 锥形管状胃在微创McKeown食管癌切除术中的疗效［D］. 成都：四川大学， 2021 .

Xiao X . The effect of cone-shaped gastric tube for McKeown minimally invasive esophagectomy ［D］. Chengdu ： Sichuan University ， 2021 .

Zheng X ， Yang Y S ， Hu W P ， et al . Coniform gastric tube for end-to-end anastomosis during minimally invasive McKeown esophagectomy ［J］. Ann Thorac Surg ， 2020 ， 109 （ 4 ）： e297 - e300 . DOI： 10.1016/j.athoracsur.2019.10.032 http://dx.doi.org/10.1016/j.athoracsur.2019.10.032 .

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

基于DAEUnet和ConvNeXt网络的食管癌智能分割与分期诊断模型构建

支气管封堵导管在胸腹腔镜联合食管癌根治术中的应用

miRNA-205在食管鳞状细胞癌患者组织中的表达及临床意义

TCF4N剪接异构体在食管癌细胞中的表达研究

微创食管癌切除术与开胸食管癌切除术术后C反应蛋白及TNF-α、IL-6反应的对比研究