摘要
目的:探讨腹腔镜下辅助切口吻合和经口置入钉砧头腔内吻合对行全胃切除术胃癌患者手术相关临床指标及术后并发症的影响。方法:纳入我院2015年1月—2020年3月收治行全胃切除术胃癌患者共176例,根据吻合方案分为两组,其中腹腔镜下辅助切口食管—空肠吻合88例(辅助切口吻合组),经口置入钉砧头腔内食管—空肠吻合88例(腔内吻合组);对两组基线特征资料、手术相关临床指标水平及围手术期并发症发生情况进行倾向性得分匹配分析,同时评估全胃切除术食管—空肠吻合口瘘发生影响因素。结果:两组基线特征资料比较差异无统计学意义(P>0.05);腔内吻合组消化道重建时间、切口长度、饮水、全流食及半流食恢复时间均显著少于辅助切口吻合组(P<0.05);两组其他手术相关临床指标水平比较差异无统计学意义(P>0.05);两组围手术期并发症发生率比较差异无统计学意义(P>0.05);单因素分析结果显示,是否行新辅助化疗、不同淋巴结清扫数目及是否联合脏器切除患者间术后食管—空肠吻合口瘘发生率比较差异有统计学意义(P<0.05);Logistic回归模型多因素分析结果显示,是否接受新辅助化疗、淋巴结清扫数目及是否联合脏器切除是影响全胃切除术后食管—空肠吻合口瘘发生独立因素(P<0.05)。结论:腹腔镜下经口置入钉砧头腔内吻合用于行全胃切除术胃癌患者能够显著缩短术中消化道重建和术后康复用时,且未增加食管—空肠吻合口瘘发生风险,价值优于腹腔镜下辅助切口。
Objective:To investigate the influence of laparoscopy assisted incision anastomosis and intraluminal anastomosis by transoral anvil on operation related clinical indexes and postoperative complications of gastric cancer patients undergoing total gastrectomy.Methods:176 gastric cancer patients undergoing total gastrectomy were retrospectively chosen in the period from January 2015 to March 2020 in our hospital and divided into 2 groups including laparoscopy assisted anastomosis group(laparoscopy assisted anastomosis group,88 patients)with laparoscopy assisted incision anastomosis and intraluminal anastomosis group(intraluminal anastomosis group,88 patients)with intraluminal anastomosis by transoral anvil;and the baseline data,the level of operation related clinical indicators and the incidence of perioperative complications were analyzed by PSM method and the influencing factors of esophagojejunostomy leakage in total gastrectomy were evaluated.Results:There was no significant difference in baseline clinical data between 2 groups(P>0.05).The digestive tract reconstruction time,incision length,drinking water recovery time,total fluid and half fluid recovery time of intraluminal anastomosis group were significantly shorter than laparoscopy assisted anastomosis group(P<0.05).There was no significant difference in the level of other surgical indications and postoperative complications incidence between 2 groups(P>0.05).Univariate analysis results showed that here were significant differences in the incidence of esophageal jejunal anastomotic leakage between the patients with or without neoadjuvant chemotherapy,with different lymph node dissection and with or without combined organ resection(P<0.05).Logistic regression analysis showed that neoadjuvant chemotherapy,lymph node dissection number and combined organ resection were the independent influencing factors for esophagojejunostomy leakage in total gastrectomy(P<0.05).Conclusion:Compared with laparoscopy assisted incision anastomosis,intraluminal anastomosis by tran
作者
田浩
罗奎
TIAN Hao;LUO Kui(Department of General Surgery,Sinopharm Dongfeng Huaguo Hospital,Shiyan City,Hubei Province 442049)
出处
《医学理论与实践》
2023年第18期3073-3076,3080,共5页
The Journal of Medical Theory and Practice
关键词
腹腔镜
全胃切除术
胃癌
吻合
Laparoscopy
Total gastrectomy
Gastric cancer
Anastomosis
