远端胃癌根治术中全腹腔镜下三角吻合与腹腔镜辅助Brillroth Ⅰ式吻合近期效果对比分析

Comparison of short-term effect of totally laparoscopic delta-shaped anastomosis with laparoscopic-assisted Brillroth Ⅰ anastomosis in radical distal gastrectomy for gastric cancer

目的对比分析远端胃癌根治术中全腹腔镜下三角吻合与腹腔镜辅助Brillroth Ⅰ式吻合的近期效果。方法纳入2012年2月至2014年10月接受诊治的远端胃癌患者86例。根据随机数字表法将其随机分为A组(n=43)和B组(n=43)。A组采用腹腔镜辅助Brillroth Ⅰ式吻合术,B组采用全腹腔镜下三角吻合术。观察两组手术时间、住院时间、术中出血量、术后排气时间、拆线时间、淋巴结清扫数目、术后并发症及死亡情况。结果 A组手术时间明显短于B组(P<0.05);A组和B组术后住院时间比较无统计学意义(P>0.05);B组术中出血量明显少于A组(P<0.05);术后排气时间、拆线时间均明显短于A组,淋巴结清扫数目明显多于A组(P<0.05);两组术后并发症发生率比较差异无统计学意义(P>0.05);两组均未出现死亡情况。结论远端胃癌根治术中全腹腔镜下三角吻合近期效果明显优于腹腔镜辅助Brillroth Ⅰ式吻合,但手术时间长于腹腔镜辅助Brillroth Ⅰ式吻合,临床上可根据患者特点选用适合的根治术,可优先考虑全腹腔镜下三角吻合术。

Objective To compare the short- term effect of totally laparoscopic delta- shaped anastomosis with laparoscopic- assisted Brillroth Ⅰ anastomosis in radical distal gastrectomy for gastric cancer. Methods Based on the random number table,86 distal gastric cancer patients treated from February 2012 to October 2014 were randomly divided into group A（ n = 43） and group B（ n = 43）. For the radical distal gastrectomy,patients in group A received laparoscopic- assisted Brillroth Ⅰ anastomosis,group B received totally laparoscopic delta- shaped anastomosis. Operation time,hospitalization time,blood loss,the time to first flatus,removing stitches time,number of lymph node dissection,postoperative complications were observed between two groups. Results Operation time in group A was significantly shorter than group B（ P〈0. 05）.Less blood loss,shorter time to first flatus and removing stitches time were observed in group B than group A（ P〈0. 05）. The number of lymph node dissected in group B was more than group A（ P〈0. 05）. No significant difference was found in postoperative hospital stay and complications between two groups（ P〉0. 05）. No patients died during the study. Conclusion Except operation time,totally laparoscopic distal gastrectomy with delta- shaped anastomosis shows better short- term efficacy than laparoscopic- assisted distal gastrectomy with Brillroth Ⅰ anastomosis.