Overlap、π-shaped、手缝荷包三种食管空肠吻合方式在SiewertⅡ型食管胃结合部腺癌腹腔镜全胃切除术后消化道重建中的应用比较

Comparative application of 3 methods of laparoscopic esophagojejunostomy with Overlap,π-shaped,and purse string suture in the reconstruction of digestive tract after radical total gastrectomy in the patients with Siewert typeⅡadenocarcinoma of the esophagogastric junction

目的:对比分析Overlap、π-shaped、手缝荷包三种食管空肠吻合方式在SiewertⅡ型食管胃结合部腺癌腹腔镜全胃切除术后消化道重建中的临床效果。方法:回顾分析2016年1月至2019年10月收治的76例SiewertⅡ型食管胃结合部腺癌患者的临床资料。均完成腹腔镜胃癌根治全胃切除术,食管空肠吻合采用Overlap(n=26)、π-shaped(n=28)、手缝荷包(n=22)三种方式。比较三种吻合方法在吻合所用时间、吻合口出血、吻合口漏、吻合口狭窄方面的差异。结果:三种吻合方法的一般资料、临床病理资料差异无统计学意义。手缝荷包应用圆形吻合器在吻合时间[(55.2±10.6)min vs.(80.5±17.8)min、(83.8±15.9)min]、吻合口漏(0 vs.5、7)方面优于Overlap、π-shaped方法;在吻合口出血、吻合口狭窄方面3组差异无统计学意义。结论:手缝荷包应用圆形吻合器的食管空肠吻合方法在SiewertⅡ型食管胃结合部腺癌消化道重建中更为适用。

Objective:To compare and analyze the clinical results of 3 methods of laparoscopic esophagojejunostomy with Overlap,π-shaped,and purse string suture after totally laparoscopic radical gastrectomy in patients with Siewert typeⅡadenocarcinoma of esophagogastric junction.Methods:Clinical data of 76 patients who underwent totally laparoscopic radical gastrectomy for Siewert typeⅡadenocarcinoma from Jan.2016 to Oct.2019 were analyzed retrospectively.Three methods of Overlap,π-shaped,and purse string suture were performed in the laparoscopic digestive tract reconstruction,in the 26 patients,28 patients,and 22 patients,respectively.The data of operative time of esophagojejunostomy,anastomotic hemorrhage,anastomotic leak,and anastomotic stricture were compared and analyzed.Results:There was no statistically significant difference in the data of general condition,clinical pathology,anastomotic hemorrhage,or anastomotic stricture.However,in the data of operative time of esophagojejunostomy[(55.2±10.6)min vs.(80.5±17.8)min;(83.8±15.9)min]and anastomotic leak(0 vs.5;7),the patients underwent esophagojejunostomy with purse string suture were superior to the patients in the other groups underwent Overlap andπ-shaped methods(P<0.05).Conclusions:Esophagojejunostomy with laparoscopic purse string suture and circular stapler is more suitable than the overlap andπ-shaped methods in digestive tract reconstruction after totally laparoscopic radical total gastrectomy in the patients with Siewert typeⅡadenocarcinoma of the esophagogastric junction.