胃癌根治术患者行三种吻合方法术后疗效分析

Three anastomosis methods in radical gastrectomy for patients with gastric cancer

目的对比胃癌根治术患者行三种吻合方法,探讨其临床适用性。方法选择从2010年5月至2015年5月138例行胃癌根治术患者,随机分为三组,分别为单层缝合组,双层缝合组和吻合器吻合组,每组46例。数据采用JMTJFX进行分析,术中、术后计量资料比较采用t检验;术后并发症情况及预后情况比较采用χ2检验,P<0.05差异具有统计学意义。结果三组患者手术均成功,未出现术中死亡病例。其中吻合器吻合组患者的手术时间最短,术中出血量最少(P<0.01);吻合器吻合组患者和单层缝合组患者排气时间和住院时间低于双层缝合组患者(t=70.73、17.55,P<0.01);吻合器吻合组患者的并发症发生率为13.0%(6/46),单层缝合组患者的并发症发生率为15.2%(7/46),双层缝合组患者的并发症发生率为69.6%(32/46),三组患者并发症发生率差异有统计学意义(χ2=42.93,P<0.05)。三组患者的肿瘤局部转移率、远处转移率、1年复发率和1年生存率均无显著差异(P>0.05)。结论单层缝合和吻合器吻合在胃癌根治术中较手法双层缝合创伤小,并发症少,临床效果显著,适合临床推广应用。

Objective To investigate the feasibility of three kinds of anastomoses in radical gastrectomy for patients with gastric cancer. Methods 138 patients with gastric cancer who had undergone radical gastrectomy from May 2010 to May 2015 were studied. They were randomly divided into three groups ： single suture group （46 patients ）, double suture group （ 46 ）, and stapling group （ 46 ）. The data of the patients were analyzed by using JMTJFX. Intraoperative and postoperative measurement data were examined by using Student＇ s t test, whereas postoperative complications and prognosis （recurrence rate, metastasis rate and survival rate） were examined using the Chi-square test. P 〈 0. 05 was considered statistically significant. Results All patients in the 3 groups underwent the operation successfully. Among the 3 groups, operation time and blood loss of patients in the stapling group was the least （ P 〈 0. 01 ）. Hospital stay and exhaust time of patients in the stapling group and single suture group were shorter than those in the double suture group （ t = 70. 73, 17.55 respectively, P 〈 0.01 ）. The complication rate in the stapling group was 13.0% （6/46） ,whereas 15.2% （7/46） in the single suture group and 69.6% （32/46） in the double suture group X2 = 42. 93, P 〈 0.05 ）. There was no significant difference between the 3 groups in local tumor metastasis rate , distant metastasis rate, 1-year recurrence rate and 1-year survival rate （ P 〉 0.05 ）. Conclusions Compared with the double suture technique, single suture and stapling in radical gastrectomy for oatients with ~astric cancer are less invasive and have fewer comnlications.