腹腔镜辅助远端胃癌根治术消化道重建方式分析

Analysis of laparoscopy-assisted radical gastrectomy in digestive tract reconstruction for distal gastric cancer

目的比较腹腔镜辅助远端胃癌根治术中消化道重建方式。方法回顾性分析51例行腹腔镜辅助远端胃癌根治术患者的病历资料,根据消化道重建方式不同将患者分为A组(n=10)、B组(n=8)、C组(n=17)、D组(n=16);A组行BillrothⅠ式吻合,B组行BillrothⅡ式吻合,C组行Roux-En-Y吻合,D组行un-Cut Roux-En-Y吻合。比较各组患者的术中及术后指标、并发症发生及预后情况。结果 51例胃癌患者的总体平均手术时间为(198.6±20.0)min,平均吻合时间为(51.7±11.4)min;A组和B组患者的手术时间、吻合时间均明显短于C组和D组(P﹤0.01)。4组患者的术中出血量、淋巴结清扫数目、肠道排气时间、拔除引流管时间及住院时间比较,差异均无统计学意义(P﹥0.05)。胃癌患者以吻合口瘘、感染为主要术后并发症。结论 4种腹腔镜辅助远端胃癌根治术消化道重建方式均是安全、可行的。4种方式各有优劣,BillrothⅠ式吻合符合生理;BillrothⅡ式吻合较BillrothⅠ式更好地解决了吻合口张力问题;Roux-En-Y吻合解决了吻合口张力过高、碱性胆汁反流等问题;un-Cut Roux-En-Y吻合在阻断空肠内容物通过的同时,保留了空肠肌电传导的连续性,一定程度上减少了滞留综合征的发生,且手术难度未明显增加,吻合时间也未明显延长,可成为较好的选择。

Objective To compare the different ways of reconstruction of digestive tract in laparoscopy-assisted radi- cal gastrectomy for distal gastric cancer. Method 51 patients with distal gastric cancer who were treated with laparosco- py-assisted radical gastrectomy were retrospectively analyzed. These patients were grouped by respective digestive tract reconstruction as group A （n=10）, group B （n=8）, group C （n=17）, and group D （n=16）, with Billroth I anastomosis, Bill- roth II anastomosis, Roux-En-Y anastomosis, and un-Cut Roux-En-Y anastomosis administered, respectively. The intraop- erative and postoperative indicators, complications and prognosis were compared. Result The overall average operative time of 51 patients with gastric cancer was （198.6±20.0） minutes, and the average time for anastomosis was （51.7± 11.4） minutes. The time of operation and anastomosis in group A and B were significantly shorter than those in group C and D （P〈0.01）. There was no significant differences in regard of intraoperative blood loss, number of dissected lymph nodes, time to intestinal exhaust, and time to extubation of the drainage tube as well as the hospital stay among the four groups （P〉0.05）. The main postoperative complications of gastric cancer were anastomotic leakage and infection. Conclusion The four types of laparoscopy-assisted radical gastrectomy for distal gastric cancer are safe and feasible. Each surgical procedure has its own advantages and disadvantages, Billroth I anastomosis is physiologically applicable; while Billroth Ⅱ anastomosis is better in regard of the anastomotic tension compared with Billroth I; Roux-En-Y anastomosis solves the problem of high tension in anastomosis, and alkaline bile reflux; however, un-Cut Roux-En-Y anastomosis may not only block the movement of jejunal contents, but also preserve the continuity of jejunal muscle electrical conductivity, which helps reduce the occurrence of stasis syndrome, meanwhile the difficulty of surgery is not significantly increased, and the time to anastomosis is not significantly longer, so it could be a relatively better choice.