完全腹腔镜下改良Roux-en-Y吻合术在胃肠手术后消化道重建中应用分析

Application of modified Roux-en-Y anastomosis in reconstruction of digestive tract with laparoscope

目的探讨完全腹腔镜下改良Roux-en-Y吻合术在胃肠手术后消化道重建中的应用。方法该院自2014年1月以后引入改良Roux-en-Y吻合术。回顾性分析2013年1月‐2014年1月该院进行手术治疗的26例胃肠道患者的临床资料,并将其作为对照组,该组患者接受完全腹腔镜下标准Roux-en-Y吻合术;另前瞻性选择了2014年1月以后的26例状况一致的胃肠道患者作为观察组,该组患者接受了完全腹腔镜下改良Roux-en-Y吻合术。对两组患者的术中出血量和手术时长进行对比,比较两组患者术后并发症发生率和术后相关营养指标。结果观察组患者手术时长显著短于对照组患者,比较差异有统计学意义(P<0.05)。观察组患者出现吻合口瘘、倾倒综合征、Roux潴留综合征和碱性反流性胃炎4种并发症的概率均明显小于对照组患者,比较差异有统计学意义(P<0.05)。术后6个月时,观察组患者体质量和血清白蛋白(ALB)下降程度显著小于对照组患者,比较差异有统计学意义(P<0.05),且术后6个月观察组患者的营养指数更佳,比较差异有统计学意义(P<0.05)。术后12个月两组患者的4项营养指标没有显著差异,比较差异无统计学意义(P>0.05)。结论采用改良Roux-en-Y吻合术可以有效缩短手术时长,降低术后并发症发生率,缩短患者恢复时间,值得临床推广。

[Objective] To investigate the application of modified Roux-en-Y anastomosis in the reconstruction of digestive tract with laparoscope. [Methods] Modified Roux-en-Y anastomosis was introduced into our hospital after January 2014. The clinical data of 26 patients underwent gastrointestinal surgery in our hospital from January 2013 to January 2014 were retrospectively analyzed and were selected as the control group. They were treated with standard Roux-cn-Y anastomosis with laparoscope. After January 2014, 26 patients under similar condition with gastrointestinal disease were selected as the observation group. They were treated with modified Roux-en-Y anastomosis with laparoscope. The amount of blood loss and the operation duration were compared between the two groups. The incidence of postoperative complications and postoperative nutritional index were compared between the two groups. [Results] The operation duration in the observation group were significantly shorter than the control group （P 〈0.05）. Patients in the observation group with anastomotic leakage, dumping syndrome, Roux retention syndrome and reflux gastritis were significantly less than those in the control group （P 〈0.05）. At 6 months after operation, the body mass and albumin decrease of the patients in the observation group were significantly lower than those in the control group （P 〈0.05）, and the nutritional index of the patients in the observation group was better （P 〈0.05）. There was no significant difference in the 4 nutritional parameters between the two groups at 12 months after the operation （P 〉0.05）. [Conclusion] Modified Roux-en-Y anastomosis can shorten the operation time, reduce the incidence of postoperative complications, and shorten the recovery time. It is worthy of clinical application.