摘要
目的研究自牵引后离断(SPLT)吻合技术在腹腔镜近端胃癌根治性切除中的应用价值。方法选择2021年1月至2022年4月在咸阳市第一人民医院拟接受腹腔镜近端胃癌根治性切除术的87例胃癌患者为研究对象,采用抽签法分为传统组(予传统全腹腔镜近端胃切除双通道重建)42例和SPLT组(予SPLT全腹腔镜近端胃切除双通道重建)45例。比较两组患者的术中、术后情况和并发症发生情况,并随访6个月,观察患者营养状况与反流性食管炎发生情况。结果SPLT组患者的消化道重建时间、下纵膈淋巴结清扫数目、中转辅助例数分别为(26.55±4.72)min、(8.05±2.24)枚、1例,明显短(多、少)于传统组的(30.81±6.28)min、(5.55±1.63)枚、7例,差异均有统计学意义(P<0.05);SPLT组患者的手术时间、术中出血量分别为(261.52±48.14)min、(114.18±35.51)mL,略长(少)于传统组的(244.49±42.84)min、(118.29±35.29)mL,但差异无统计学意义(P>0.05);SPLT组患者术后进食时间、术后排便时间、术后下床活动时间分别为(2.82±0.76)d、(3.04±0.91)d、(1.52±0.39)d,明显短于传统组的(3.53±1.05)d、(3.82±1.21)d、(1.84±0.57)d,差异均有统计学意义(P<0.05);SPLT组患者的住院时间为(12.48±2.37)d,略短于传统组的(13.05±2.51)d,但差异无统计学意义(P>0.05);SPLT组患者术后并发症总发生率为6.67%,明显低于传统组的26.19%,差异有统计学意义(P<0.05);SPLT组患者术后体质量指数、白蛋白、预后营养指数分别为(24.77±2.26)kg/m^(2)、(51.67±7.34)g/L、49.82±5.65,略高于传统组的(23.98±2.65)kg/m^(2)、(49.35±6.55)g/L、48.26±5.16,反流性食管炎发生率为2.22%,略低于传统组的9.52%,但差异均无统计学意义(P>0.05)。结论相较于传统的双通道重建,SPLT吻合技术应用于腹腔镜近端胃癌根治性切除中,不仅可缩短消化道重建时间,增加下纵膈淋巴结清扫数量,降低中转辅助发生率,而且还可以加速患者术后恢复,降
Objective To study the application value of self-pulling and latter transection(SPLT)anastomosis technique in laparoscopic radical resection of proximal gastric cancer.Methods Eighty-seven patients with gastric cancer who were scheduled to undergo laparoscopic radical resection of proximal gastric cancer in the First People’s Hospital of Xianyang from January 2021 to April 2022 were selected and divided into traditional group(traditional total laparoscopic radical resection of proximal gastric cancer with double-tract reconstruction,n=42)and SPLT group(SPLT total laparoscopic radical resection of proximal gastric cancer with double-tract reconstruction,n=45)by the lottery method.The intraoperative and postoperative conditions and occurrence of complications were compared between the two groups After 6 months of follow-up,the nutritional status and occurrence of reflux esophagitis were observed.Results The time of digestive tract reconstruction,the number of dissected lower mediastinal lymph nodes,and the number of cases with conversion to auxiliary surgery in SPLT group were(26.55±4.72)min,8.05±2.24,and 1 case,which were significantly shorter/more/less than(30.81±6.28)min,5.55±1.63,and 7 cases in traditional group(P<0.05).The surgical time and intraoperative blood loss in SPLT group were(261.52±48.14)min and(114.18±35.51)mL,which were slightly longer or less than(244.49±42.84)min,and(118.29±35.29)mL in traditional group(P>0.05).Postoperative feeding time,postoperative defecation time,and postoperative ambulation time were(2.82±0.76)d,(3.04±0.91)d,and(1.52±0.39)d in SPLT group,significantly shorter than(3.53±1.05)d,(3.82±1.21)d,and(1.84±0.57)d in traditional group(P<0.05).The length of hospital stay was(12.48±2.37)d in SPLT group,slightly shorter than(13.05±2.51)d in traditional group(P>0.05).The total incidence rate of postoperative complications in SPLT group was 6.67%,which was significantly lower than 26.19%in traditional group(P<0.05).The postoperative body mass index,albumin and prognostic
作者
马宁
许诚
孙娇娜
施大为
丛仔红
郭玲
刘永存
MA Ning;XU Cheng;SUN Jiao-na;SHI Da-wei;CONG Zi-hong;GUO Ling;LIU Yong-cun(Department of Oncology,Department of Anesthesiology,Xianyang 712000,Shaanxi,CHINA;Department of Oncology,Department of Pathology,Xianyang 712000,Shaanxi,CHINA;Department of Oncology,the First People’s Hospital of Xianyang,Xianyang 712000,Shaanxi,CHINA)
出处
《海南医学》
CAS
2023年第19期2792-2796,共5页
Hainan Medical Journal
基金
陕西省咸阳市二〇二〇年重点研发计划项目(编号:2020K02-105)。
关键词
近端胃癌
腹腔镜
双通道重建
自牵引后离断吻合
食管-空肠吻合
Proximal gastric cancer
Laparoscopic
Double-tract reconstruction
Self-pulling and latter transec-tion anastomosis
Esophago-jejunal anastomosis
