全腹腔镜远端胃癌根治术非离断式Roux-en-Y吻合与传统吻合疗效对照多中心研究

Comparison of uncut Roux-en-Y anastomosis and traditional Roux-en-Y anastomosis in the totally laparoscopic distal gastrectomy for gastric cancer: An analysis of multiple centers' data

目的对比非离断式(Uncut)Roux-en-Y吻合和传统Roux-en-Y吻合应用于全腹腔镜远端胃癌根治术后消化道重建的安全性和短期疗效。方法回顾性分析国内10家单位共60例远端胃癌根治术后全腹腔镜消化道重建的胃癌病人临床资料,根据消化道重建方式不同分为Uncut Roux-en-Y组(Uncut组)34例,传统Roux-enY组(传统组)26例。结果 Uncut Roux-en-Y吻合在消化道重建时间方面用时更短[(51.5±13.3)min vs.(80.4±16.2)min,P=0.000],出血量更少[(60.0±35.6)m L vs.(132.9±65.1)m L,P=0.000],且在进食半流饮食时间方面具有优势[(4.6±1.5)d vs.(7.2±2.3)d,P=0.000]。两组病人在留置胃管时间、术后排气时间、进食流质时间和术后住院时间方面差异无统计学意义。两组病人均无围手术期死亡病例,并发症发生率差异无统计学意义(8.8%vs.7.7%,P=0.875)结论 Uncut Roux-en-Y吻合和传统Roux-en-Y吻合应用于全腹腔镜下消化道重建安全可行,Uncut Roux-en-Y吻合在重建时间和控制出血量方面具有优势。

Objective To compare the security and short-term effect of the digestive tract reconstruction during the totally laparoscopic distal gastrectomy for gastric cancer between the Uncut Roux-en-Y anastomosis and the traditional Roux-en-Y anastomosis. Methods The clinical data of 60 gastric cancer patients with digestive reconstruction underwent totally laparoscopie distal gastrectomy between December 2012 and June 2015 in 10 domestic hospital were analyzed retrospectively. According to the difference of digestive reconstruction, it can be divided into the Uncut Roux-en-Y anastomosis group with 34 patients and the traditional Roux-en-Y anastomosis group with 26 patients. Results In uncut Roux-en-Y anastomosis group, the operative time in digestive reconstruction was shorter [ （51.5 ± 13.3） rain vs. （80.4± 16.2） min, P = 0.000]; the intraoperative blood loss was less [ （60.0±35.6） mL vs. （132.9±65.1） mL, P = 0.000]; semi-liquid diet time was earlier [ （4.6± 1.5） d vs. （7.2± 2.3） d, P = 0.000]. However, there was nodifference between the two groups on nasogastric tube, gastrointestinal transit, fluid diet and the duration of postoperative hospital stay. Both groups had no death case during the perioperative period and there was no significant statistical difference in the postoperative complication rates （8.8% vs. 7.7%, P = 0.875）. Conclusion The Uncut Roux-en-Y anastomosis and the traditional Roux-en-Y anastomosis are both safe and feasible for the digestive reconstruction under the totally laparoscopic distal gastrectomy for gastric cancer.Besides, the Uncut Roux-en-Y anastomosis has other advantages such as less reconstruction time and less bleeding.