全腹腔镜下圆形吻合器与直线切割闭合器行食管空肠吻合疗效对照研究

Various types of intracorporealesophagojejunostomy after laparoscopic total gastrectomy for gastric cancer:A national multi-center retrospective study

目的对比圆形吻合器和直线切割闭合器应用于全腹腔镜全胃切除术后消化道重建的安全性和短期疗效。方法回顾性分析224例全胃切除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圆形吻合器吻合组(圆形吻合组)90例,直线切割闭合器吻合组(直线吻合组)134例。结果直线吻合组在消化道重建时间方面用时更短(47.4 min vs.52.3 min P=0.015),两组在出血量、近切缘及重建费用方面差异无统计学意义。两组病人在术后排气时间、进食流质时间、半流饮食时间和术后住院时间方面差异均无统计学意义。两组病人均无围手术期死亡病例,并发症发生率差异亦无统计学意义(11.1%vs.11.9%,P=0.849)。结论圆形吻合器和直线切割闭合器应用于全胃术后全腹腔镜下消化道食管空肠重建安全可行,直线切割闭合器方式在消化道重建时间方面具有优势。

Objective To compare the security and short-term effect of the digestive reconstruction during the totally laparoscopic total gastrectomy for gastric cancer between the circular anastomosis and linear anastomosis. Methods The clinical data of 224 gastric cancer patients with digestive reconstruction underwent totally laparoscopic total gastrectomy between January 2011 and June 2016 in 17 domestic hospitals were analyzed retrospectively.According to the difference of digestive reconstruction, all the patients can be divided into the circularanastomosis with 90 patients and the linear anastomosis with 134 cases.Results The operative time in digestive reconstruction with linear anastomosis was shorter （47.4 min vs. 52.3 min, P=0.015）. There was no difference between the two groups on the intraoperative blood loss, near cutting margin, cost of the reconstruction, postoperative exhaust time, fluid diet, soft 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 of the postoperative complication rate（11.1% vs.11.9% , P= 0.849）. Conclusion The circular anastomosis and linear anastomosis are both safe and feasible for the digestive reconstruction under the totally laparoscopic total gastrectomy for gastric cancer. Besides, the linear anastomosis has the advatage of the less reconstruction time.