腹腔镜胃癌根治术中不同迷走神经保留策略对患者术后胃肠功能及营养代谢的影响OA

Objective To investigate the impact of different vagus nerve preservation strategies on postoperative gastrointestinal functional reconstruction and nutritional metabolic status in patients undergoing laparoscopic radical gastrectomy for gastric cancer.Methods A retrospective analysis was conducted on 136 patients who underwent laparoscopic radical gastrectomy in the Gastrointestinal Surgery Department of Qingdao Jiaozhou Central Hospital from January 2022 to June 2024.According to the intraoperative vagus nerve preservation strategy,the patients were divided into three groups:the group with preservation of both hepatic and abdominal vagus nerves(dual nerve preservation group,n=42),the group with preservation of only the hepatic vagus nerve(hepatic nerve preservation group,n=51),and the group with transection of both vagus nerves(transection group,n=43).Early postoperative gastrointestinal functional recovery indicators,6-month gastric emptying function,and changes in nutritional metabolic parameters were compared among the three groups.Multivariate regression analysis was employed to identify independent predictors affecting postoperative functional recovery.Results Baseline characteristics were comparable among the three groups(P＞0.05).Motilin levels demonstrated significant between-group effects and time ×group interaction effects,with the dual nerve preservation group recovering to near preoperative levels at 6 months postoperatively,while the transection group showed limited recovery.Cholecystokinin levels showed significant between-group differences(P=0.001),with optimal recovery in the dual nerve preservation group at 6 months postoperatively.Among nutritional metabolic indicators,serum albumin levels at 6 months postoperatively in the dual nerve preservation group(44.7±4.2)g/L were significantly superior to the hepatic nerve preservation group(41.4±4.8)g/L and transection group(40.6±5.1)g/L.Multivariate regression analysis revealed that vagus nerve preservation strategy was the most important independent predictor affecting postoperative gastric emptying function and nutritional metabolic recovery(P＜0.001).Dual nerve preservation group compared to vagotomy improved 6-month postoperative gastric emptying rate by 9.6％(β=0.404,95％CI:5.7～13.5,P＜0.001)and serum albumin recovery rate by 6.2％(β=0.344,95％CI:2.9～9.5,P＜0.001).Advanced age,increased tumor size,and TNM stage progression were all unfavorable for postoperative functional recovery(P＜0.05).There was no statistically significant difference in the survival rates among the three groups during the 1-year postoperative follow-up(P＞0.05).Conclusion Hepatic and abdominal vagus nerve preservation strategy in laparoscopic radical gastrectomy significantly improves postoperative gastrointestinal functional recovery and nutritional metabolism,without sacrificing the radical tumor,serving as an independent predictor of postoperative functional reconstruction.