根治性远端胃切除术胃-空肠侧侧和端侧吻合临床疗效的对比研究

A comparative study of side-to-side and end-to-side anastomosis after radical distal gastrectomy

目的:比较开放根治性远端胃切除术胃-空肠侧侧吻合和端侧吻合在胃癌治疗中的临床效果差异。方法:回顾东南大学附属中大医院普外科2013年1月至2019年12月175例行两种术式患者的临床资料,其中端侧吻合组103例,侧侧吻合组72例。比较两组患者手术时间、术中出血量、术后并发症发生率、住院时间、总费用等情况。结果:所有病例均顺利完成了根治性远端胃切除(D2淋巴结廓清术)和消化道重建。两组共26例(15%)患者出现术后胃瘫,其中侧侧吻合组6例(6/72,8%),端侧吻合组20例(20/103,20%),差异有统计学意义(P=0.04);侧侧吻合组平均住院时间为20 d,端侧吻合组平均住院时间为25 d,差异有统计学意义(P=0.02)。两组患者的一般情况及病史资料,如年龄、性别、体质指数(BMI)等差异无统计学意义(P>0.05);两组在手术时间、术中出血量、术后吻合口并发症(非胃瘫)、其他并发症以及住院总费用方面,差异均无统计学意义(P>0.05)。结论:胃-空肠侧侧吻合较端侧吻合能降低术后胃瘫的发生风险,并缩短住院时间。

Objective:To compare the clinical effects of open radical gastrectomy for gastric-jejunal side-to-side anastomosis and end-to-side anastomosis in the treatment of gastric cancer.Methods:To review the clinical data of175 patients who underwent two surgical procedures from January 2013 to December 2019 in Southeast University Affiliated Zhongda Hospital,including 103 cases in end-to-side anastomosis group and 72 cases in side-to-side anastomosis group.The operation time,bleeding volume,postoperative complication rate,hospital stay,and total cost of the two groups were compared.Results:All patients successfully completed radical distal gastrectomy(D2 lymphadenectomy)and gastrointestinal reconstruction.A total of 26 patients(15%)in both groups developed postoperative gastroparesis,6 patients in the side-to-side anastomosis group(6/72,8%)and 20 patients in the end-toside anastomosis group(20/103,20%),the difference was statistically significant(P=0.04);the median hospital stay in the side-to-side anastomosis group was 20 days,and the median hospital stay in the end-to-side anastomosis group was 25 days,the difference was statistically significant(P=0.01).There was no statistically significant difference between the general condition and medical history of the two groups of patients,such as age,gender,BMI,etc.(P>0.05);the operation time,bleeding volume,postoperative anastomotic complications(nongastric paralysis),other complications and total hospitalization costs were no statistically significant differences(P>0.05).Conclusion:Gastric-jejunal side-to-side anastomosis can reduce the risk of postoperative gastroparesis and shorten the length of hospitalization.Linear stapler is easy to operate and may reduce anastomosis related complications.