全腹腔镜全胃切除术食管空肠吻合术反穿刺法与Overlap法的比较

Comparative Analysis of Reverse Puncture Device and Overlap Methods of Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy

目的比较反穿刺法与Overlap法在全腹腔镜全胃切除术(totally laparoscopic total gastrectomy,TLTG)食管空肠吻合中的应用效果。方法回顾性分析我院2017年1月~2018年12月75例TLTG的临床资料,依据食管空肠重建方式不同,分为反穿刺组(n=41)和Overlap组(n=34)。结果75例均顺利完成全TLTG。与Overlap组比较,反穿刺组吻合时间[(46.4±6.3)min vs(52.9±4.6)min,t=-5.028,P=0.000]和术后住院时间[(11.0±1.3)d vs(11.6±1.2)d,t=-2.363,P=0.021]明显缩短,住院费用明显减少[(44720.7±3499.2)元vs.(48164.6±5536.5)元,t=-3.274,P=0.002],但肠道恢复时间显著延长[(3.8±1.1)d vs.(3.2±0.6)d,t=2.675,P=0.009]。2组总手术时间、术中出血量、清扫淋巴结数目差异无统计学意义(P>0.05)。结论全腹腔镜下食管空肠吻合术管型吻合的反穿刺法和线型吻合的Overlap法均安全可行,但反穿刺法在吻合时间和手术费用上更有优势。

Objective To compare the application effects of esophagojejunostomy between reverse puncture device(RPD) and Overlap methods in totally laparoscopic total gastrectomy(TLTG). Methods From January 2017 to December 2018, the data of 75 cases of totally laparoscopic total gastrectomy in our hospital were analyzed retrospectively. They were divided into two groups: the reverse puncture device group(n=41) and the Overlap group(n=34). Results All the laparoscopic operations in the 75 cases were successfully performed. As compared to the Overlap group, the reverse puncture device group had shorter anastomotic time [(46.4±6.3) min vs.(52.9±4.6) min, t=-5.028, P=0.000], shorter postoperative hospital stay [(11.0±1.3) d vs.(11.6±1.2) d, t=-2.363, P=0.021], and less hospitalization costs [(44 720.7±3499.2) yuan vs.(48 164.6±5536.5) yuan, t=-3.274, P=0.002], but longer first flatus time [(3.8±1.1) d vs.(3.2±0.6) d, t=2.675, P=0.009]. The difference was not statistically significant in operation time, intraoperative blood loss, number of lymph nodes and postoperative complications between the two groups(P>0.05). Conclusion The methods of RPD(circle stapler) and Overlap(liner stapler) in esophagojejunostomy are both feasible and safe in TLTG for gastric cancer, but the method of RPD has advantages in hospitalization expenses and anastomosis time.