腹腔镜与开腹全胃切除非离断式食道空肠Roux-en-Y吻合的临床疗效

Clinical efficacy of uncut Roux-en-Y esophagojejunostomy after laparoscopic and open total gastrectomy

目的:比较腹腔镜与开腹全胃切除非离断式食道空肠Roux-en-Y吻合的疗效。方法:回顾性收集2013年10月至2017年3月武汉市红十字会医院普外科收治的胃体癌患者53例,根据手术方式不同,分为腹腔镜手术组(A组,27例)与开腹手术组(B组,26例),其中A组又分为完全腹腔镜组(totally laparoscopic group,TLG;17例)与腹腔镜辅助组(laparoscopy-assisted group,LAG;1 0例),比较各组的手术时间、消化道重建时间、术中出血量、术后排气时间、住院时间和费用及近期并发症。结果:A组与B组手术时间[(248±83.5)min vs(203.6±69.6)min]、消化道重建时间[(44.2±9.0)min vs(30.2±7.8)min]及术中出血量[(231.8±145.2)m L vs(326.8±182.1)m L],差异均有统计学意义(t=2.098,P=0.040;t=6.041,P<0.001;t=-2.103,P=0.040);A组与B组排气时间[(3.1±0.5)d vs(4.6±0.5)d]、住院时间[(9.4±1.5)d vs(14.6±2.0)d]及住院费用[(3.1±0.3)万元vs(4.2±0.2)万元],差异均有统计学意义(t=-10.918,P<0.001;t=-10.735,P<0.001;t=-15.643,P<0.001)。TLG组与LAG组手术时间[(299±88)min vs(232±55)min]、消化道重建时间[(58.2±6.0)min vs(33.2±3.9)min]及术中出血量[(216.1±36)m L vs(281.5±93)m L],差异有统计学意义(t=2.162,P=0.0 4 0;t=1 1.7 4 7,P<0.0 0 1;t=-2.6 1 3,P=0.0 1 4);T L G组与L AG组排气时间[(3.6±0.5)d v s(2.8±0.5)d]、住院时间[(9.8±1.2)d vs(9.0±1.8)d]及住院费用[(3.1±0.2)万元vs(3.3±0.4)万元],差异无统计学意义(P>0.05)。A组与B组术后并发症发生率差异无统计学意义(P>0.05)。结论:较之开腹手术,腹腔镜全胃切除非离断式食道空肠Roux-en-Y吻合术术中出血少,恢复排气时间快,住院时间短,住院费用低,但手术时间与消化道重建时间长。

Objective： To compare the efficacy of uncut Roux-en-Y esophagojejunostomy after laparoscopy total gastrectomy and open total gastrectomy. Methods： A total of 53 patients with gastric body carcinoma from Oct 2013 to Mar 2017 in our hospital were retrospectively collected and analyzed. The patients were divided into laparoscopic group （group A, 27 cases） and open surgical group （group B, 26 cases） according to the type of operation, and group A was further divided into totally laparoscopic group （TLG group, 17 cases） and laparoscopy-assisted group （LAG group, 10 cases）. The observation index included operation time, reconstruction time, blood loss volume, the first time to flatus, hospital day and expenses, and early post complications. Results： The differences in operation time [（248±83.5） min vs （203.6±69.6） min], reconstruction time [（44.2±9.0） min vs （30.2±7.8） min] and blood loss volume [（231.8±145.2） mL vs （326.8±182.1） mL] between group A and B were statistically significant （t=2.098, P=0.040; t=6.041, P〈0.001; t=-2.103, P=0.040）; the differences in the first time to flatus [（3.1±0.5） d vs （4.6±0.5） d], hospital day [（9.4±1.5） d and （14.6±2.0） d] and expenses [（31 000±3 000） yuan vs （42 000±2 000） yuan] of group A and group B were statistically significant （t=-10.918, P〈0.001; t=-10.735, P〈0.001; t=-15.643, P〈0.001）. The operation time, reconstruction time and blood loss volume of TLG and LAG were （299±88） min vs （232±55） min, （58.2±6.0） min vs （33.2±3.9） min, （216.1±36） mL vs （281.5±93） mL, respectively. This difference was significant （t=2.162, P=0.040; t=11.747, P〈0.001; t=-2.613, P=0.014）. The first time to flatus, hospital day and expenses of group A and group B was （3.6±0.5） d vs （2.8±0.5） d, （9.8±1.2） d vs （9.0±1.8） d, and （31 000±2 000） yuan vs （33 000±4 000） yuan, respectively. The difference was not significant （P〉0.05）. The difference of early post complications occurred in group A and B was not significant （P〉0.05）. Conclusion： Compared with open total gastrectomy, uncut Roux-en-Y esophagojejunostomy after laparoscopic total gastrectomy is characterized by less blood loss volume, shorter flatus and hospitalization time and less hospitalization expenses, however, longer operation time and reconstruction time. Keywords： laparoscopy; uncut Roux-en-Y reconstruction; total gastrectomy Objective： To compare the efficacy of uncut Roux-en-Y esophagojejunostomy after laparoscopy total gastrectomy and open total gastrectomy. Methods： A total of 53 patients with gastric body carcinoma from Oct 2013 to Mar 2017 in our hospital were retrospectively collected and analyzed. The patients were divided into laparoscopic group （group A, 27 cases） and open surgical group （group B, 26 cases） according to the type of operation, and group A was further divided into totally laparoscopic group （TLG group, 17 cases） and laparoscopy-assisted group （LAG group, 10 cases）. The observation index included operation time, reconstruction time, blood loss volume, the first time to flatus, hospital day and expenses, and early post complications. Results： The differences in operation time [（248±83.5） min vs （203.6±69.6） min], reconstruction time [（44.2±9.0） min vs （30.2±7.8） min] and blood loss volume [（231.8±145.2） mL vs （326.8±182.1） mL] between group A and B were statistically significant （t=2.098, P=0.040; t=6.041, P〈0.001; t=-2.103, P=0.040）; the differences in the first time to flatus [（3.1±0.5） d vs （4.6±0.5） d], hospital day [（9.4±1.5） d and （14.6±2.0） d] and expenses [（31 000±3 000） yuan vs （42 000±2 000） yuan] of group A and group B were statistically significant （t=-10.918, P〈0.001; t=-10.735, P〈0.001; t=-15.643, P〈0.001）. The operation time, reconstruction time and blood loss volume of TLG and LAG were （299±88） min vs （232±55） min, （58.2±6.0） min vs （33.2±3.9） min, （216.1±36） mL vs （281.5±93） mL, respectively. This difference was significant （t=2.162, P=0.040; t=11.747, P〈0.001; t=-2.613, P=0.014）. The first time to flatus, hospital day and expenses of group A and group B was （3.6±0.5） d vs （2.8±0.5） d, （9.8±1.2） d vs （9.0±1.8） d, and （31 000±2 000） yuan vs （33 000±4 000） yuan, respectively. The difference was not significant （P〉0.05）. The difference of early post complications occurred in group A and B was not significant （P〉0.05）. Conclusion： Compared with open total gastrectomy, uncut Roux-en-Y esophagojejunostomy after laparoscopic total gastrectomy is characterized by less blood loss volume, shorter flatus and hospitalization time and less hospitalization expenses, however, longer operation time and reconstruction time.