摘要
目的评价胃癌患者接受全腹腔镜下全胃切除术(totally laparoscopic total gastrectomy,TLTG)后应用改良Overlap法实施消化道重建的临床效果。方法回顾性分析2014年1月至2017年1月兰州大学第一医院收治TLTG的86例胃癌患者资料,均施行D2淋巴结清扫术。其中44例以传统Overlap法行消化道重建(对照组),另42例以改良Overlap法行消化道重建(改良组)。对两组患者术中和术后情况、术后无瘤生存、肿瘤复发转移等情况进行统计对比。随访时间截至2018年2月。结果两组均成功实施TLTG,无一例中转开腹。改良组食管空肠吻合时间[(20.4±2.3)min与(46.5±4.4)min,t=9.493]、总手术时间[(253.3±12.8)min与.(278.6±14.9)min,t=5.462]均较对照组明显缩短,两组比较差异均有统计学意义(P均<0.05)。改良组与对照组术中出血量[(71.5±12.9)ml与(73.2±15.3)ml,t=0.286]、淋巴结清扫数[(35.5±4.8)枚与(34.2±5.6)枚,t=0.618]、术后首次排气时间[(2.6±0.9)d与(2.7±1.1)d,t=0.348]、术后住院时间[(9.9±1.6)d与(9.8±1.7)d,t=0.229]及术后并发症[7.1%(3/42)与9.1%(4/44),χ^2=0.207]比较差异均无统计学意义(P均>0.05)。两组均获随访12~25个月,均无一例发生肿瘤复发转移情况。结论TLTG应用改良Overlap法实施消化道重建,相对于传统Overlap法吻合过程简化、手术时间缩短、吻合效果有效可靠。
Objective To evaluate the clinical effect of modified Overlap method in digestive tract reconstruction of totally laparoscopic total gastrectomy(TLTG)for gastric cancer.Methods The data of 86 patients with gastric cancer who underwent TLTG from January 2014 and January 2017 were collected from the First Hospital of Lanzhou University.All the patients underwent D2 lymphadenectomy.Forty-four patients′digestive tracts were reconstructed with traditional Overlap method(control group),and 42 patients′digestive tracts were reconstructed with modified Overlap method(modified group).The intraoperative and postoperative conditions,postoperative tumor-free survival,tumor recurrence and metastasis were compared between the two groups.Follow up lasted as of February 2018.Results TLTG was successfully performed in both groups,and no case was converted to laparotomy.The time of esophagojejunostomy((20.4±2.3)min vs.(46.5±4.4)min,t=9.493),total operation time((253.3±12.8)min vs.(278.6±14.9)min,t=5.462)in the modified group were significantly shorter than those in the control group,and there were significant differences between the two groups(all P<0.05).And there were no significant differences between the the modified group and control group in volume of intraoperative blood loss((71.5±12.9)ml vs.(73.2±15.3)ml,t=0.286),number of lymph node dissected((35.5±4.8)vs.(34.2±5.6),t=0.618),first postoperative exhaust time((2.6±0.9)d vs.(2.7±1.1)d,t=0.348),postoperative hospitalization time((9.9±1.6)d vs.(9.8±1.7)d,t=0.229)and postoperative complications(7.1%(3/42)vs.9.1%(4/44),χ^2=0.207)(all P>0.05).The two groups were followed up for 12~25 months.No recurrence or metastasis occurred.Conclusion Compared with traditional Overlap method,the modified Overlap method can simplify the anastomotic procedures,shorten operation time and achieve an effective and reliable anastomosis effect after TLTG.
作者
马宝录
曹农
Ma Baolu;Cao Nong(Department of General Surgery,Traditional Chinese Medicine Hospital of Zhangjiachuan Hui Autonomous County,Tianshui 741500,China;Department of General Surgery,the First Hospital of Lanzhou University,Lanzhou 730000,China)
出处
《中国综合临床》
2019年第4期364-367,共4页
Clinical Medicine of China
