钉砧系统在肥胖患者腹腔镜全胃切除术后消化道重建中的应用

Application of Or Vil System in Digestive Tract Reconstruction After Laparoscopic Total Gastrectomy for Gastric Cancer in Obese Patients

目的探讨腹腔镜全胃切除术后消化道重建采用钉砧头系统(OrVil)在腔内行食管空肠Roux-en-Y吻合的临床应用价值。方法回顾性分析我科2015年1月~2018年1月采用腹腔镜全胃根治术+D2淋巴结清扫+OrVil腔内行食管空肠Roux-en-Y吻合消化道重建治疗28例SiwertⅡ、Ⅲ型肥胖胃癌作为实验组,筛选同期年龄、性别、体重指数、ASA分级、病理分期、TNM分期、合并症及肿瘤位置等与实验组组患者无明显差异的28例肥胖胃癌作为对照组,并行腹腔镜全胃根治术+D2淋巴结清扫+开腹辅助食管空肠Roux-en-Y吻合。比较2组患者的术中、术后情况。结果实验组消化道重建时间(48.6±6.9)min,明显短于对照组(55.7±5.6)min(t=4.193,P=0.000);食管空肠吻合时间(12.5±2.5)min,明显短于对照组(20.4±3.3)min(t=10.055,P=0.000);切口长度(5.2±1.0)cm,明显短于对照组(10.7±2.1)cm(t=12.469,P=0.000);术后镇痛时间(2.6±0.5)d,明显短于对照组(3.2±0.8)d(t=2.903,P=0.005);肛门排气时间(3.2±0.5)d,明显少于对照组(3.8±0.8)d(t=3.635,P=0.001);进流质饮食时间(3.2±0.6)d,明显少于对照组(4.0±0.6)d(t=4.688,P=0.000);术后住院时间(7.8±1.2)d,明显短于对照组(9.0±1.4)(t=-3.629,P=0.001)。2组术中冰冻切缘阳性率(3.6%vs.10.7%)(χ^2=0.269,P=0.604)和淋巴结清扫数目[(27.0±6.3)枚vs.(27.5±6.3)枚,t=-0.277,P=0.783]无统计学差异。2组并发症发生率差异无显著性(P>0.05)。结论腹腔镜全胃切除术后消化道重建采用OrVil在腔内进行食管空肠吻合操作,可缩短吻合时间,腹部切口小、疼痛时间短促进患者胃肠道功能较早的恢复,加快患者康复的过程。

Objective To evaluate the clinical application of the OrVil system in intraluminal Roux-en-Y esophagojejunostomy for digestive tract reconstruction after laparoscopic total gastrectomy.Methods From January 2015 to January 2018,28 obese cases of Siwert typeⅡorⅢgastric cancer(experimental group)were treated by laparoscopic total gastrectomy and D2 lymph node dissection and digestive tract reconstruction with the OrVil system intraluminal Roux-en-Y anastomosis in our department.Another 28 cases,without significantly different age,gender,body mass index,ASA classification,pathological stage,TNM stage,comorbidities and tumor location were regarded as the control group.Laparoscopic total gastrectomy and D2 lymph node dissection and laparotomy assisted Roux-en-Y esophagojejunostomy were performed.The intraoperative and postoperative conditions of the two groups were compared.Results The time of digestive tract reconstruction in the experimental group was significantly shorter than that in the control group[(48.6±6.9)min vs.(55.7±5.6)min,t=4.193,P=0.000];the time of esophagojejunostomy was significantly shorter than that in the control group[(12.5±2.5)min vs.(20.4±3.3)min,t=10.055,P=0.000];the length of incision was significantly less than that in the control group[(5.2±1.0)cm vs.(10.7±2.0)cm,t=12.469,P=0.000];the time of postoperative analgesia was significantly shorter than that in the control group[(2.6±0.5)d vs.(3.2±0.8)d,t=2.903,P=0.005];the time of anal exhaust was significantly less than that of control group[(3.2±0.5)d vs.(3.8±0.8)d,t=3.635,P=0.001];the time to liquid diet intake was significantly less than that of control group[(3.2±0.6)d vs.(4.0±0.6)d,t=4.688,P=0.000];the hospital stay after operation was significantly less than that of the control group[(7.8±1.2)d vs.(9.0±1.4),t=-3.629,P=0.001].There were no statistical differences in the positive rate of frozen margin during operation(3.6%vs.10.7%,χ^2=0.269,P=0.604)and the number of lymph node dissection[(27.0±6.3)vs.(27.5±6.3),t=0.277,P=0.783].There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions After laparoscopic total gastrectomy,gastrointestinal reconstruction with OrVil system can shorten the time of anastomosis.In addition,small abdominal incision and short pain time can accelerate the process of getting out of bed,thus promoting the early recovery of gastrointestinal function.