完全腹腔镜下食管空肠π吻合术与腹腔镜小切口辅助下端侧吻合术对胃体癌的疗效

Totally laparoscopic π-shape esophageal jejunostomy vs. laparoscopic assisted end-to-side esophageal jejunostomy in radical D2 total gastrectomy for gastric cancer

目的探讨完全腹腔镜下食管空肠π吻合术与腹腔镜小切口辅助下端侧吻合术在胃体癌中的疗效。方法收集2015年7月至2017年7月福建医科大学附属龙岩第一医院胃肠外科行腹腔镜下全胃D2根治性切除术的154例胃体癌患者的临床资料，其中62例行完全腹腔镜下π吻合术，92例行腹腔镜小切口辅助下食管空肠端侧吻合术。结果两组患者的肿瘤病理学特性、术后总并发症方面差异均无统计学意义（均P〉0．05）；两组患者的吻合口重建手术时间分别为（21±3）、（30±3）min，差异有统计学意义（t=17．56，P=0．000）；切口长度分别为（6．7±1．1）、（10．5±1．7）em，差异有统计学意义（t=15．72，P=0．000）；吻合口并发症发生率分别3％、13％，差异有统计学意义（X^2=4．320，P=0．038）。结论完全腹腔镜下食管空肠竹吻合术是安全可行的，较传统的腹腔镜小切口辅助下食管空肠端侧吻合在吻合口相关并发症、吻合手术时间、切口长度方面具有优势。

Objective To evaluate laparoscopic π-shaped esophageal jejunostomy vs. laparoscopic assisted end-to-side esophageal jejunostomy in D2 radical total gastreetomy for middle third gastric cancer. Methods From July 2015 to July 2017, 154 patients undergoing laparoscopic D2 radical total gastrectomy were divided into group of laparoscopic assisted end-to-side esophageal jejunostomy （92 cases ） and the group of totally laparoscopic ＂π-shaped esophageal jejunostomy （62 cases ）. Results The group of totally laparoseopic w-shaped esophageal jejunostomy was not statistically different in tumor pathology and postoperative complications with laparoscopic assisted group, but was better than the later in anastomotic reconstruction surgery time （21±3） min vs. （30±3） min, t = 17.56, P = 0. 000, incision length （ 6.7±1.1 ） cm vs. （ 10.5±1.7） cm,t=15.72, P=0. 000 and anastomotic complications （3% vs.13%,X^2=4.320, P=0.038 ）. Conclusions Totally laparoscopic π-shape esophageal jejunostomy is safe, feasible, better than hand assisted procedures.