非离断式Roux-en-Y吻合在全腹腔镜根治性全胃切除术消化道重建中的可行性研究

Feasibility study of uncut Roux-en-Y anastomosis in totally laparoscopic radical total gastrectomy and reconstruction of digestive tract

目的探究非离断式Roux-en-Y吻合在全腹腔镜根治性全胃切除术消化道重建中的安全性及可行性。方法回顾性分析2015年6月至2017年5月接受全腹腔镜根治性全胃切除术的75例胃癌患者临床资料,根据术中消化道重建术式不同进行分组,非离断组37例,行非离断式Roux-en-Y吻合,传统组38例行传统Roux-en-Y吻合。采用统计软件SPSS 20.0进行数据分析,围手术指标、血清营养指标等计量资料采用(x±s)表示,行独立t检验;近远期并发症等行χ^2检验或Fisher检验,P<0.05差异有统计学意义。结果非离断组在手术总时间、消化道重建时间、术中出血量、恢复排气时间、首次进食时间、住院时间方面明显优于传统组(P<0.05),两组术中均无中转开腹。传统组近、远期并发症总发生率(13.2%、 21.1%)明显高于非离断组(2.7%、 5.4%),差异有统计学意义(P<0.05)。非离断组患者术后短期疗效及胆汁反流情况均优于传统组(P<0.05)。术后3个月两组血清营养指标逐渐恢复,非离断组高于传统组(P<0.05)。结论非离断式Roux-en-Y吻合应用于全腹腔镜根治性全胃切除术消化道重建中安全可行,值得临床推广使用。

Objective To explore the safety and feasibility of uncut Roux-en-Y anastomosis in totally laparoscopic radical total gastrectomy and reconstruction of digestive tract. Methods The clinical data of 75 patients with gastric cancer who underwent totally laparoscopic radical total gastrectomy from June 2015 to May 2017 were retrospectively analyzed. They were divided into two groups according to different reconstruction methods of digestive tract. 37 patients in the uncut group were treated with uncut Roux-en-Y anastomosis, while 38 patients in the traditional group were treated with conventional Roux-en-Y anastomosis. Statistical software SPSS 20.0 was used for data analysis. Perioperative indicators, serum nutritional indicators and other measurement data were represented by (x±s), and compared with independent t test. χ^2 test or Fisher test was performed for the short and long term complications, and P<0.05 showed statistically significant difference. Results The uncut group was significantly superior to the traditional group in terms of total operation time, digestive tract reconstruction time, intraoperative blood loss, recovery of exhaust time, first feeding time and hospital stay(P<0.05). The total incidence of short-term and long-term complications in the traditional group(13.2%, 21.1%) was significantly higher than those in the uncut group(2.7%, 5.4%)(P<0.05). The short-term postoperative efficacy and bile reflux ratio of patients in the uncut group were better than those in the traditional group(P<0.05). Three months after the operation, the serum nutrition indexes of the two groups recovered gradually, and the difference between the uncut group and the traditional group was statistically significant,the former was better( P < 0. 05). Conclusion The uncut Roux-en-y anastomosis is safe and feasible in totally laparoscopic radical total gastrectomy and is worthy of clinical application.