摘要
背景与目的:腹腔镜胃癌根治术已成为胃癌外科治疗的首选手术方式,主要包括肿瘤的根治性切除和消化道重建两个部分,其中消化道重建是手术中的技术难点,尤其是全腹腔镜下的食管空肠吻合术,是难度系数最大的操作技术,极大地制约了全腹腔镜根治性全胃切除术的临床开展。食管空肠π吻合术是基于直线切割闭合器的线性吻合技术,据报道可以简化手术流程并缩短手术时间。因此,本研究旨在探讨食管空肠π吻合在全腹腔镜根治性全胃切除术中的应用价值。方法:回顾性分析2016年1月—2020年1月芜湖市第二人民医院胃肠外科收治的78例胃癌患者的临床资料,所有患者均行全腹腔镜下全胃切除术和D2淋巴结清扫术,其中40例消化道重建食管空肠π吻合(观察组),38例采用传统食管空肠功能性端端吻合(对照组)。比较两组患者术中、术后相关临床指标。结果:所有患者均顺利完成全腹腔镜全胃切除、淋巴结清扫及消化道重建,无1例患者发生中转开腹情况,食管切缘均为阴性。与对照组比较,观察组手术时间、食管空肠吻合时间均明显缩短、术中出血量明显减少(217.4 min vs.237.9 min;22.6 min vs.34.8 min;64.4 mL vs.99.2 mL,均P<0.05);首次下床活动时间与术后首次排气时间均明显缩短(1.5 d vs.2.3 d;2.6 d vs.2.9 d,均P<0.05)。观察组有3例发生术后并发症,对照组有2例发生术后并发症,两组术后并发症发生率比较差异无统计学意义(P=0.687)。两组的术后住院时间与结清扫数目差异无统计学意义(均P>0.05)。随访3~12个月,所有患者吻合口均通畅。结论:食管空肠π吻合应用于全腹腔镜根治性全胃切除术中安全可行,与传统的食管空肠功能性端端吻合法相比,其具有手术时间和食管空肠吻合时间短,术后恢复快的优势,且短期临床疗效满意。
Background and Aims:Laparoscopic radical gastrectomy has become the first choice for surgical treatment of gastric cancer.The surgical procedure mainly comprises radical resection of the tumor and digestive tract reconstruction.Digestive tract reconstruction is a difficult technique during the operation,and especially,the totally laparoscopic esophagojejunostomy is the most difficult procedure to perform,which greatly restricts the clinical development of totally laparoscopic radical total gastrectomy.Theπ-shaped esophagojejunostomy is a linear anastomosis technique based on a linear cutting closure device,which is reported to simplify the procedure and shorten the operative time.Therefore,this study was conducted to evaluate the application value ofπ-shaped esophagojejunostomy in totally laparoscopic radical total gastrectomy.Methods:The clinical data of 78 patients with gastric cancer treated in the Department of Gastrointestinal Surgery of Wuhu Second People’s Hospital between January 2016 and January 2020 were retrospectively analyzed.All patients underwent total laparoscopic gastrectomy with D2 lymphadenectomy.Of the patients,40 cases underwentπ-shaped esophagojejunostomy(observation group)and 38 cases underwent traditional functional end-to-end esophagojejunostomy(control group)for digestive tract reconstruction.The main intra-and postoperative variables were compared between the two groups of patients.Results:Total gastrectomy,lymphadenectomy and digestive tract reconstruction were uneventfully completed in all patients under totally laparoscopic surgery,none required open conversion and all had a negative esophageal margin.In observation group compared with control group,the total operative time and the operative time for esophagojejunostomy were significantly shortened,and the intraoperative blood loss was significantly decreased(217.4 min vs.237.9 min;22.6 min vs.34.8 min;64.4 mL vs.99.2 mL,all P<0.05);the time to first ambulation and the time to first flatus passage after the operation were all si
作者
姚远
方可
张正君
李光耀
YAO Yuan;FANG Ke;ZHANG Zhengjun;LI Guangyao(Department of Gastrointestinal Surgery,Wuhu Second People's Hospital,Wuhu,Anhui 241000,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2020年第10期1204-1211,共8页
China Journal of General Surgery
基金
南通大学临床基础研究专项基金资助项目(2019JQ015)。
关键词
胃肿瘤
胃切除术
食管空肠吻合术
腹腔镜
Stomach Neoplasms
Gastrectomy
Esophagojejunostomy
Laparoscopes
