腹腔镜根治性远端胃切除两种消化系统重建的疗效分析

Efficacy analysis of two types of digestive tract reconstruction in laparoscopic radical distal gastrectomy

目的:探讨腹腔镜根治性远端胃大部切除胃-空肠Roux-en-Y Uncut型吻合(Uncut型)和Roux-en-Y吻合(R-Y型)两种消化系统重建的临床疗效。方法:回顾性分析2015年3月至2016年3月86例行腹腔镜辅助根治性远端胃大部切除术病人的临床资料,根据病人术中胃-空肠消化系统重建方式的不同将病人分为观察组和对照组,观察组行胃-空肠Uncut型吻合,对照组采用胃-空肠R-Y型吻合。对比2组病人在总手术时间、术中总出血量、术后肛门通气时间、术后进食流质时间、术后Roux潴留综合征(RSS)发生率及术后住院时间等指标的差异。结果:2组总手术时间方面差异无统计学意义(P>0.05)。在术中总出血量、术后肛门通气时间、术后进食流质时间、术后RSS发生率及术后住院时间方面差异有统计学意义(P<0.05~P<0.01)。结论:在腹腔镜远端胃癌根治性切除术中,胃-空肠Uncut型吻合较R-Y型吻合可减少术后RSS并发症发生率,缩短术后住院时间短,近期疗效确切,一定程度上可改善病人的术后生活质量,在腹腔镜远端胃癌根治术中是一种安全有效的手术方式。

Objective： To explore the clinical effects of Roux-en-Y Uncut anastomosis（Uncut type） and Roux-en-Y anastomosis（R-Y type） in laparoscopic radical distal gastrectomy.Methods： The clinical data of 86 patients treated with laparoscopic radical distal gastrectomy from March 2015 to March 2016 were retrospectively analyzed.The patients were divided into the observation group and control group according to the different ways of reconstruction of gastrointestinal jejunum.The observation group was anastomosed with Uncut type of gastric jejunum,and the control group was anastomosed with R-Y type of gastric jejunum.The total operation time,intraoperative total bleeding,postoperative anus ventilation time,postoperative feeding fluid time,postoperative Roux retention syndrome（RSS） and postoperative hospitalization time between two groups were compared.Results： The difference of the total operative time between two groups was not statistically significant（ P 〉0.05）.The differences of the intraoperative total bleeding,postoperative anus ventilation time,postoperative feeding fluid time,postoperative RSS and postoperative hospitalization time between two groups were statistically significant（ P 〈0.05 to P 〈0.01）.Conclusions： In laparoscopic radical resection of distal gastric carcinoma,the incidence of postoperative RSS complications and postoperative hospital stay in patients treated with gastric jejunal Uncut type anastomosis were less than those in patients treated with R-Y type anastomosis.The gastric jejunal Uncut type anastomosis has good effect,and is a safe and effective operation method,which can improve the postoperative quality of life of patients.