摘要
目的比较远端胃癌根治术中B—II＋Braun与UncutRoux—en—Y吻合的围术期指标及消化道重建效果。方法回顾性分析2014年1月至2017年1月行全腹腔镜远端胃癌根治术患者的临床资料，根据患者消化道重建方式将其分为观察组和对照组，其中34例行UncutRouxen—Y吻合的患者为观察组，26例行B—II＋Braun吻合的患者为对照组。所有患者临床资料完整，比较两组患者手术时间、淋巴结清扫数目、术中出血量、切口长度等围术期指标，术后P．oux潴留综合征（RSS）、碱性反流性胃炎、吻合口瘘及小肠梗阻等并发症的发生率，并比较两组患者术后6个月生存情况及胃肠道造影情况。结果两组患者在手术时间、术中出血量、切口长度、重建时间及首次进食时间比较差异无统计学意义（P〉005）；观察组患者首次排气时间（3．13±1．28）d明显短于对照组（3．87±1．45）d，差异有统计学意义（t=2．06，P=0．04）；观察组患者肠道恢复时间（3．19±0．33）d明显短于对照组（3．65±0．45）d，差异有统计学意义（t=439，P=000）。观察纽患者出现吻合口瘘、创面感染各1例，对照组患者出现2例P．SS，吻合口瘘、创面感染、小肠梗阻、倾倒综合征及胃瘫各1例；观察组患者术后并发症总发生率（5．88％）明显低于对照组（26．92％），差异有统计学意义（x2=6．57，P=0．01）；且观察组患者未发现碱性反流性胃炎，对照组患者碱性反流性胃炎的发生率11.54％，两组比较差异有统计学意义（x2=4.13，P=004）。术后随访6个月，两组患者均未出现肿瘤复发及远处转移，患者均存活，生活质量基本达正常水平，行胃镜及胃肠道造影观察其胃肠道情况，患者吻合口愈合情况良好，空肠阻断效果良好，无再通发生。结论全腹腔镜远端胃癌根治术的临床疗效显著，B—II＋Braun和UncutRoux—en—Y吻合方�
Objective To compare and analyze the perioperative indexes and digestive tract reconstruction of B-II ± Braun and Uncut Roux- en-Y in radical gastrectomy of distal gastric cancer. Methods A total of 60 patients underwent total laparoscopic radical gastrectomy from January 2014 to January 2017 in our hospital were retrospectively analyzed. According to the patients＇ digestive tract reconstruction, they were divided into observation group and control group, of which 34 patients with Uncut Roux-en-Y anastomosis were observed group, and 26 patients with B-II±Braun anastomosis were the control group. The clinical data of all patients were complete. The operative time, number of lymph node dissection, intraoperative blood loss and incision length were compared between the two groups. Roux stasis syndrome （ RSS ） , alkaline reflux gastritis, anastomotic fistula and small intestine obstruction and other complications, and the two groups of patients were compared after 6 months of survival and gastrointestinal imaging. Results There was no significant difference in operative time, intraoperative blood loss, incision length, reconstruction time and time to first meal between the two groups （P〉0.05） . The time of the first evacuation in the observation group [ （3.13 ± 1.28 ） d ] was significantly shorter （3.87 ± 1.33 ） d in the control group （t=2.06, P=0.04 ） . The intestinal recovery time in the observation group [ （3.19 ± 0.33 ） d ] was significantly shorter than that in the control group （3.65 ± 0.45 ） d, the difference was statistically significant （ t=4.39, P=0.00 ） . In the observation group, there were only 1 case of anastomotic leakage and wound infection, 1 case of RSS, anastomotic fistula, wound infection, small bowel obstruction, dumping syndrome and gastroparesis in the control group. The postoperative complications and overall incidence （ 5.88% ） were significantly lower than that of the control group （ 26.92% ） , with significant difference （ X 2=6.57, P=0.
出处
《浙江临床医学》
2018年第9期1493-1495,共3页
Zhejiang Clinical Medical Journal
