摘要
目的探讨常规辅助切口和OrVilTM腔内食管-空肠吻合对行腹腔镜全胃切除术(LTG)胃癌患者围手术期临床指标及安全性的影响。方法回顾性分析行LTG胃癌患者共207例临床资料,其中行常规辅助切口腔内食管-空肠吻合185例设为对照组,行OrVilTM腔内食管-空肠吻合22例设为观察组;采用PSM法进行1∶1匹配后比较两组基线临床资料、围手术期临床指标水平、术后及术后并发症发生率,同时采用单因素和logistic回归模型多因素分析LTG术后食管-空肠吻合口漏发生危险因素。结果 (1)PMS法匹配后两组基线临床资料比较差异无统计学意义(P>0.05);(2)观察组消化道重建时间、切口长度、饮水恢复时间、全流食恢复时间及半流食恢复时间均显著短于对照组(P<0.05);(3)两组术中术后并发症发生率比较差异无统计学意义(P>0.05);(4)单因素分析结果显示,是否接受新辅助化疗、淋巴结清扫数目及是否行脏器切除与LTG术后食管-空肠吻合口漏发生有关(P<0.05);(5)logistic回归模型多因素分析结果显示,接受新辅助化疗、淋巴结清扫数目≥36枚及联合脏器切除是LTG术后食管-空肠吻合口漏发生独立危险因素(P<0.05);而行OrVilTM腔内食管-空肠吻合与TG术后食管-空肠吻合口漏发生无关(P>0.05)。结论相较于常规辅助切口,行LTG胃癌患者采用OrVilTM腔内食管-空肠吻合可有效缩短消化道重建所需时间,加快术后康复进程,且安全性良好;同时行OrVilTM腔内食管-空肠吻合并未增加术后食管-空肠吻合口漏发生风险。
Objective To investigate the influence of routine auxiliary incision esophagojejunostomy and OrVilTM intraluminal esophagojejunostomy on perioperative clinical parameters and safety of patients with gastric cancer undergoing LTG. Methods Clinical data of 207 patients with gastric cancer undergoing LTG were retrospectively selected and divided into control group(185 patients), in which the patients received routine auxiliary incision esophagojejunostomy, and observation group(22 patients), in which patients received OrVilTM intraluminal esophagojejunostomy. The baseline clinical data, the levels of perioperative clinical indicators, and postoperative complications incidence of 2 groups were compared.Results There was no significant difference in baseline clinical data between 2 groups after PMS matching(P>0.05). The digestive tract reconstruction time, incision length, drinking water recovery time, total fluid and half fluid recovery time of observation group were significantly shorter than control group(P<0.05). There was no significant difference in postoperative complications incidence between the 2 groups after PMS matching(P>0.05). Univariate analysis results showed that neoadjuvant chemotherapy, lymphadenectomy and organ resection were correlated with the esophageal jejunal anastomotic leakage after LTG(P<0.05). Logistic regression analysis showed that neoadjuvant chemotherapy, lymphadenectomy and combined organ resection were the independent risk factors for esophagojejunostomy leakage after LTG(P<0.05). There was no correlation between the intraluminal esophagojejunostomy of OrVilTM and the esophagojejunostomy leakage after TG(P>0.05). Conclusion Compared with routine auxiliary incision esophagojejunostomy, OrVilTM intraluminal esophagojejunostomy in the treatment of patients with gastric cancer undergoing LTG can efficiently shorten the digestive tract reconstruction time, accelerate the recovery process after operation and safety. OrVilTM intraluminal esophagojejunostomy doesn′t increase the risk of es
作者
乔海军
赵小勇
张博涛
QIAO Hai-jun;ZHAO Xiao-yong;ZHANG Bo-tao(Department of General Surgery,Central Hospital of Jiaozuo Coal Industry(Group)Co.,Ltd,Jiaozuo 454150,Henan,China)
出处
《广东医学》
CAS
2020年第4期400-405,共6页
Guangdong Medical Journal
关键词
腹腔镜
全胃切除术
胃癌
消化道重建
食管-空肠吻合
laparoscopy
total gastrectomy
gastric cancer
reconstruction of digestive tract
esophagojejunostomy
