非离断式Roux-en-Y吻合在腹腔镜远端胃癌根治术中的应用

Use of Uncut Roux-en-Y Reconstruction in Laparoscopic-assisted Distal Gastrectomy for Gastric Carcinoma

目的探讨非离断(uncut)Roux-en-Y吻合技术在腹腔镜辅助远端胃癌根治术消化道重建中的安全性和效果。方法回顾性分析2017年1月~2018年1月腹腔镜辅助远端胃癌根治术70例资料,2017年1~6月行Roux-en-Y吻合(26例,RY组),2017年7月~2018年1月行非离断Roux-en-Y吻合(44例,Uncut RY组)。术后随访6个月以上,比较其术后恢复情况、并发症发生率。结果Uncut RY组排气时间[(29.0±7.4)h]早于RY组[(38.0±5.7)h](t=-5.311,P=0.000),Roux瘀滞综合征(Roux stasis syndrome,RSS)发生率(0%,0/44)低于RY组(34.6%,9/26)(P=0.000)。术后6个月,Uncut RY组体重、血浆白蛋白水平达到术前的比例高于RY组[68.2%(30/44)vs.42.3%(11/26),χ^2=4.509,P=0.034;81.8%(36/44)vs.50.0%(13/26),χ^2=7.879,P=0.005]。结论非离断Roux-en-Y吻合术后并发症发生率低,能明显改善胃癌患者手术后生活质量及营养状况,是腹腔镜辅助远端胃癌根治术理想的消化道重建术式。

Objective To evaluate the safety and efficacy of uncut Roux-en-Y anastomosis in laparoscopic-assisted distal gastrectomy with gastrointestinal reconstruction.Methods From January 2017 to January 2018,70 cases of laparoscopic assisted distal gastrectomy for gastric cancer were analyzed retrospectively.A total of 26 cases between January to June of 2017 underwent Roux-en-Y anastomosis(RY group),and 44 cases after July 2017 underwent uncut Roux-en-Y anastomosis(Uncut RY group).All the patients were followed up for more than 6 months,and the recovery and complication rate were compared.Results The time to flatus in the uncut RY group[(29.0±7.4)h]was earlier than that in the RY group[(38.0±5.7)h,t=-5.311,P=0.000],and the incidence of Roux stasis syndrome(RSS)was lower in the uncut RY group(0%,0/44)than that in the RY group(34.6%,9/26;P=0.000).The proportion that body weight and plasma albumin had reached preoperative levels in the uncut RY group was higher than those in the RY group[68.2%(30/44)vs.42.3%(11/26),χ^2=4.509,P=0.034;81.8%(36/44)vs.50.0%(13/26),χ^2=7.879,P=0.005].Conclusions The uncut Roux-en-Y anastomosis has advantage in improving the living quality and nutritional status of patients.It may be the preferred technique for reconstruction after laparoscopic-assisted gastrectomy.