反穿刺技术在腹腔镜全胃根治术中的随机对照研究

Randomized Controlled Study on Reverse Puncture Technique for Esophagojejunostomy in Laparoscopic Radical Total Gastrectomy

目的探讨腹腔镜全胃根治术中应用反穿刺技术放置食管残端抵钉座的可行性及近期疗效。方法 2014年5月~2016年8月,60例腹腔镜根治性全胃切除术患者,采用信封法随机分为反穿刺组和常规组各30例,常规组食管空肠吻合采用常规荷包缝合置入抵钉座,反穿刺组使用反穿刺技术完成抵钉座放置,其余手术方式2组相同。比较2组手术相关指标和术后恢复情况。结果与常规组相比,反穿刺组放置抵钉座时间短[(11.5±2.6)min vs.(13.1±3.2)min,t=-2.123,P=0.038],手术时间短[(226.2±22.4)min vs.(239.2±23.5)min,t=-2.195,P=0.032],切除食管长[(4.6±1.2)cm vs.(2.9±1.0)cm,t=2.388,P=0.020],引流管留置时间短[(8.4±1.7)d vs.(9.8±2.4)d,t=-2.541,P=0.014],2组术中出血量、淋巴结清扫数目、排气时间、留置胃管时间、术后住院时间和并发症发生率差异无统计学意义(P>0.05)。2组均随访6个月,未发生远期并发症及复发。结论反穿刺技术可以安全应用于腹腔镜全胃根治术中,且近期疗效良好。

Objective To evaluate the feasibility and efficacy of application of reverse puncture technique for esophagojejunostomy in laparoscopic radical total gastrectomy. Methods From May 2014 to August 2016,60 gastric cancer patients were randomly divided into either the reverse puncture group（30 cases） or routine group（30 cases）. The routine group was given routine purse-string suturing for anvil placement,while the reverse puncture group had anvil placement by using reverse puncture technique. The operation related parameters and postoperative recovery effects were compared between the two groups. Results Compared to the routine group,the reverse puncture group had shorter anvil placement time [（11. 5 ± 2. 6） min vs.（13. 1 ± 3. 2）min,t =-2. 123,P = 0. 038],shorter operation time [（226. 2 ± 22. 4） min vs.（239. 2 ± 23. 5） min,t =-2. 195,P = 0. 032],longer resected esophageal length [（4. 6 ± 1. 2） cm vs.（2. 9 ± 1. 0） cm,t = 2. 388,P = 0. 020],and shorter postoperative drainage time [（8. 4 ± 1. 7） d vs.（9. 8 ± 2. 4） d,t =-2. 541,P = 0. 014]. The intraoperative blood loss,resected lymph nodes number,postoperative stomach tube time,first flatus time,postoperative hospital stay and overall incidence of complications had no statistical difference between the two groups（P〈0. 05）. During a 6 months ＇ follow-up,no complications or recurrence were observed.Conclusion Laparoscopic radical total gastrectomy by using reverse puncture technique is feasible and safe with a good short-term efficacy.