非离断Roux-en-Y吻合在全腹腔镜下远端胃癌根治术消化道重建中应用的多中心数据回顾分析

Retrospective analysis of multi-center data on the application of uncut Roux-en-Y gastrojejunostomy in totally laparoscopic distal gastrectomy

目的探讨非离断（Uncut）Roux-en-Y吻合术应用于全腹腔镜远端胃癌根治术消化道重建中的安全性和可行性。方法回顾性分析2014年2月至2015年1月间在广东省人民医院、吉林大学第二医院、上海瑞金医院和福建省肿瘤医院4家医疗中心接受全腹腔镜下远端胃癌根治术加Uncut Roux-en-Y吻合术的30例胃癌患者的临床资料。结果30例胃癌患者分别为广东省人民医院8例、吉林大学第二医院9例、上海瑞金医院4例和福建省肿瘤医院9例。术前均经病理诊断为远端胃癌，且未发现远处转移；ⅠA期7例，ⅠB期4例，ⅡA期6例，ⅡB期5例，ⅢA期5例，ⅢB期1例，ⅢC期2例。手术主刀医师均有50例以上全腹腔镜胃癌根治手术经验。全组患者均顺利完成手术，切口长度（4.8±1.2）cm，手术总时间（223.5±47.2）min，消化道重建时间（52.8±10.9） min，术中出血量（53.0±30.7）ml，淋巴结清扫数目（36.9±0.9）枚，无一例中转开腹。术后胃管留置时间（2.5±1.2）d，首次排气时间（2.9±0.9）d，流质饮食时间（2.9±1.2）d。全组无围手术期死亡病例，术后出现淋巴漏和腹腔出血各1例，均经保守治疗治愈；无一例出现术后输入袢阻断部位复通。结论Uncut Roux-en-Y吻合应用于远端胃癌根治术后的全腹腔镜消化道重建安全可行。

Objective To investigate the feasibility and safety of uncut Roux-en-Y gastroduodenostomy in totally laparoscopic distal gastrectomy （TLDG） for gastric cancer. Methods Clinical data of 30 gastric cancer patients from 4 hospitals undergoing TLDG plus uncut Roux-en-Y gastroduodenostomy from February 2014 to January 2015 were analyzed retrospectively. Results Among 30 gastric cancer patients, 8 were in Guangdong General Hospital, 9 in The Second Hospital of Jilin University, 4 in Ruijin Hospital and 9 in Fujian Provincial Cancer Hospital, who were diagnosed as distal gastric cancer by pathology without distant metastasis. The clinical staging of these patients was stage Ⅰ A in 7 cases, stage Ⅰ B in 4, stage Ⅱ A in 6, stage Ⅱ B in 5, stage Ⅲ A in 5, stage Ⅲ B in 1, stage Ⅲ C in 2. All the main surgeons were experienced with more than 50 operations of totally laparoscopic distal gastrectomy for gastric cancer. All the 30 patients completed operations successfully. The incision length was （4.8 ± 1.2） cm, total operation time and anastomosis time was （223.5 ± 47.2） and （52.8 ± 10.9） minutes, intra-operative blood loss was （53.0 ± 30.7） ml and number of harvested lymph nodes was 36.9± 0.9. No case was transferred to open operation. The detain time of gastric tube was （2.5 ± 1.2） days, the first time to flatus was （2.9 ±0.9） days and the first time to liquid diet intake was （2.9 ± 1.2） days. No perioperative death was found. Postoperative lymphatic leakage occurred in 1 case and peritoneal bleeding occurred in 1 case, which was cured by conservative treatment. No one developed anastomosis-related complication. Conclusion Uncut Roux-en-Y gastroduodenostomy reconstruction is safe and feasible in totally laparoscopic distal gastrectomy for gastric cancer.