腹腔镜全胃切除术两种消化道重建方式对肠道通透性影响研究

Clinical investigation of the intestinal mucosal permeability after laparoscopic radical total gastrectomy by using Un-cut or traditional Roux-en-Y anastomosis

目的比较非离断式与传统式Roux-en-Y吻合在腹腔镜根治性全胃切除术重建中的疗效及对患者肠道黏膜通透性的影响。方法回顾性分析2017年1月至2019年2月收治的60例行腹腔镜根治性全胃切除术的胃癌患者。根据术中消化道重建方式不同,将行非离断式Roux-en-Y吻合的30例患者列为A组,传统式Roux-en-Y吻合的30例列为B组。应用SPSS23.0统计软件进行统计分析,围手术指标、肠道黏膜通透性指标等计量资料以(±s)表示,比较采用独立t检验;术后并发症采用χ^2检验,P<0.05表示差异有统计学意义。结果A组术中出血量少于B组,术后恢复排气时间短于B组(P<0.05)。B组发生RSS的发生率高于A组(P<0.05)。A组L/M数值、血浆D-乳酸水平、血清内毒素水平、DAO值均低于B组,血浆Gln水平高于B组,组间差异有统计学意义(P<0.05)。结论非离断式Roux-en-Y吻合较传统式相比具有出血量少、肛门恢复排气时间快、Roux瘀血综合征发生率低等临床优势,且对患者肠道通透性的影响较小,可推广应用。

Objective To investigate the intestinal mucosal permeability of patients after laparoscopic radical total gastrectomy by using Un-cut or traditional Roux-en-Y anastomosis.Methods Retrospective analysis were performed in 60 patients with gastric cancer from January 2017 to February 2019,who underwent laparoscopic radical total gastrectomy.According to the method of digestive tract reconstruction,30 patients with Un-cut Roux-en-Y anastomosis were divided into group A,while 30 patients with traditional Roux-en-Y anastomosis were divided into group B.Statistical analysis were perfomed by using SPSS23.0 software.Measurement data such as perioperative indicators,intestinal mucosal permeability indicators were represented as(±s)and were examined by using independent t test.Postoperative complications were analyzed by usingχ^2 test.A P value of<0.05 was considered as statistical significant difference.Results The intraoperative blood loss in group A was less than that in group B,and the postoperative recovery and exhaust time were shorter than those in group B,with significant difference(P<0.05).The incidence of RSS in group B was higher than that in group A,with significant difference(P<0.05).The L/M value,plasma d-lactic acid level,serum endotoxin level and DAO value in group A were lower than those in group B,and the plasma Gln level was higher than those in group B,with significant difference(P<0.05).There was no significant difference between the two groups in terms of perioperative indicators and incidence of complications(P>0.05).Conclusion Compared with traditional Roux-en-Y anastomosis,Un-cut Roux-en-Y anastomosis has the clinical advantages of less blood loss,faster recovery of exhaust time,lower incidence of Roux stasis syndrome,and less influence on intestinal permeability of patients,which could be popularized and applied.