全腔镜远端胃癌Uncut Roux-en-Y吻合疗效探讨

The efficacy of Uncut Roux-en-Y anastomosis in distal gastric carcinoma with total endoscopy

目的:对比全腔镜远端胃癌D2根治(totally laparoscopic distal gastrectomy,TLDG)应用直线切割缝合器与手工缝合非离断式(Uncut) Roux-en-Y消化道重建方式与开腹远端进展期胃癌D2根治(open distal gastrectomy,ODG)应用常规圆形吻合器Uncut Roux-en-Y消化道常规重建方式的临床疗效。方法:回顾性分析我院2015年11月至2017年10月收治的84例远端进展期胃癌病例,其中观察组(A组,n=42)行TLDG:应用直线切割缝合器与手工缝合的Uncut Roux-en-Y消化道重建;对照组(B组,n=42)行ODG:应用常规圆形吻合器的Uncut Roux-en-Y消化道常规重建。随访4～27个月,无死亡病例,A组有1例肝转移,B组有2例局部复发。对两组病人的术中、术后资料进行统计学分析。结果:两组病人的术中出血量、手术时间、清扫淋巴结数目、并发症等差异无统计学意义;观察组患者切口总长度、排气时间、住院时间均较对照组明显减少,但住院费用较对照组增加,统计分析差异均有统计学意义。结论:TLDG应用直线切割缝合器与手工缝合的Uncut Roux-en-Y消化道重建方式有效、安全,并且具有康复较快、创伤痛苦更小、美容效果佳等优点,近期肿瘤学疗效与开腹手术相当,长期疗效需要进一步观察。

Objective： To compare the clinical curative effect of the Uncut Roux-en-Y digestive tract reconstruction by linear stapler and manual suturing after totally laparoscopic distal gastric cancer radical D2 and the Uncut Roux-en-Y conventional reconstruction of digestive tract after open distal gastric cancer radical D2 by the conventional circular stapler. Methods： From November 2015 to October 2017,the data of 84 cases of distal advanced gastric cancer patients in our hospital were analysed retrospectively. There are two groups： The observation group（ group A,n= 42） of the Uncut Roux-en-Y digestive tract reconstruction by linear stapler and manual suturing after totally laparoscopic distal gastric cancer radical D2 and the control group（ group B,n = 42） of the Uncut Roux-en-Y conventional reconstruction of digestive tract after open distal gastric cancer radical D2 by the conventional circular stapler.After 4 ～ 27 months of follow-up,there were no cases of death. There was 1 case of liver metastases in group A,and 2 cases of local recurrence in group B. The statistical analysis was made on the operative and postoperative data of the two groups of patients. Results： There were no significant differences in intraoperative blood loss,operation time,number of lymph nodes and complications between the two groups. The difference between the study group and control group was statistically significant in the total length of the incision,exhaust time,hospitalization time and hospitalization expenses,and these of the observation group were reduced compared with the control group,but the hospitalization expenses were increased compared to the control group. Conclusion： The Uncut Roux-en-Y digestive tract reconstruction by linear stapler and manual suturing after totally laparoscopic distal gastric cancer radical D2 is effective,safe and feasible. It has the advantages of quicker recovery,less trauma,and good cosmetic efficiency. Its curative effect of oncology is similar to that of laparotomy in the near future,and the long-term effect should be further observed.