全胃切除术后完全腹腔镜下改良Roux-en-Y吻合的优势探讨

Advantage investigation of totally laparoscopic modified Roux-en-Y reconstruction

目的探讨完全腹腔镜下改良Roux．en—Y吻合术在腹腔镜下全胃切除术后消化道重建中应用的优势与劣势。方法2014年1-12月吉林大学第二医院胃肠外科同一手术组共对术前胃镜活检诊断为胃腺癌的36例患者实施了完全腹腔镜下全胃切除加Roux—ell—Y消化道重建术。其中传统Roux-en-Y吻合术（传统组）16例，改良Roux—en—Y吻合术（改良组）20例，比较两组的术中及术后情况。结果所有病例均顺利完成手术，无中转开腹。与传统组相比，改良组患者手术时间[（260．9±21．2）min比（287．9±19．0）min，P=0．000]和消化道重建时间[（32．4±9．2）min比（45．4±13．2）rain，P=0．001]明显缩短，术中出血量明显减少f（50．9±23．5）ml比（67．0±20．5）ml，JP=0．000]，无需修剪系膜及切除肠管；而两组淋巴结清扫数目、术后排气时间、住院时间及术后并发症发生率的差异均无统计学意义（均P〉0．05）。结论与传统Roux-en-Y吻合术相比，改良Roux-en-Y吻合术简化了手术步骤，并能达到相近的手术效果，是全胃切除术后一种安全有效、简单易行的完全腹腔镜下消化道重建方式。

Objective To investigate the clinical advantage of the application of modified Roux- en-Y reconstruction after totally laparoseopic total gastrectomy. Methods Clinical data of 36 patients who underwent totally laparoscopic total gastrectomy with Roux-en-Y reconstruction by one medical team for gastric adenocarcinoma between January. 2014 and December 2014 in the Second Hospital of Jilin University were retrospectively analyzed. Patients were divided into classic Roux-en-Y group （CRY, 16 cases） and modified Roux-en-Y group （MRY, 20 cases） according to reconstructive methods. The data concerning the intraoperative and postoperative situation in two groups were compared. Results Operation was successfully completed in all the cases without conversion to laparotomy. Compared to CRY group, MRY group had shorter mean operative time [ （260.9± 21.2） rain vs. （287.9± 19.0） min, P = 0.000], shorter mean reconstruction duration [（32.4±9.2] rain vs. （45.4 ±13.2） min, P = 0.001] and less intraoperative bleeding [（50.9±23.5） ml vs. （67.0 ±20.5） ml, P= 0.000]. Jejunum mesentery dissection and jejunum resection were not necessary in MRY group. However, there were no significant differences in lymph nodes harvested, time to flatus, hospital stay and postoperative complications between two groups. Conclusions As compared to classic Roux-en-Y reconstruction, the modified Roux-en-Y reconstruction can simplify the surgical procedures and achieve similar efficacy. It is feasible and safe, and worth further promotion in clinical practice.