远端胃癌根治术中两种消化道重建方式的效果研究

Study on the effect of two kinds of digestive tract reconstruction methods in distal radical gastrectomy

目的研究优先离断十二指肠的两种消化道重建方式在全腹腔镜远端胃癌根治术的临床效果。方法回顾性分析2014年1月至2016年6月行全腹腔镜下行远端胃癌根治术的远端胃癌患者43例。根据胃十二指肠切除吻合技术的不同,将使用三枚直线切割吻合器的23例患者设为三枚组,使用四枚直线切割吻合器的20例患者设为四枚组。使用统计学软件SPSS 24.0进行临床数据分析,两组围术期各项指标等计量资料以(±s)表示,采用独立样本t检验;术后并发症及3年生存率采用χ2检验。P<0.05为检验标准。结果两组患者均成功完成手术。四枚组手术时间、吻合时间均较三枚组短(P<0.05),术中出血量、术后首次排气时间及术后住院时间两组差异无统计学意义(P>0.05);三枚组术后并发症发生率为13.0%,四枚组发生率为15.0%(P>0.05);术后6个月,三枚组发生倾倒综合征、肠梗阻等近期并发症发生率为17.8%,四枚组为15.0%(P>0.05);三枚组和四枚组患者术后3年生存率分别为56.5%(13/23)及55.0%(11/20),两组比较差异无统计学意义(P>0.05)。结论全腹腔镜远端胃癌根治术中优先离断十二指肠采用四枚直线切割吻合器进行消化道重建,操作更容易掌握,且安全可靠。

Objective To study the clinical effect of first amputation of duodenum in total laparoscopic distal radical gastrectomy for gastric cancer.Methods From January 2014 to June 2016,43 patients with distal gastric cancer underwent total laparoscopic radical gastrectomy in our hospital were analyzed retrospectively.According to the different techniques of operation,23 patients were divided into three-staple cartridge group and 20 patients were divided into four-staple cartridge group.Statistical software SPSS 24.0 was used for data analysis.The perioperative indicators and other measurement data of the two groups were presented as(±s),and the independent sample t test was used for inter-group comparison.The postoperative complications and 3-year survival rate were determined byχ2 test.P<0.05,was the test standard.Results The operation was successfully completed in both groups.The operation time and anastomotic time of the four-staple cartridge group were shorter than those of the three-staple cartridge group,and the differences were statistically significant(P<0.05).In the comparison of intraoperative blood loss,postoperative first exhaust time and postoperative hospital stay,there was no significant difference between the two groups(P>0.05).The incidence of postoperative complications was 13.0%in the three-pieces group and 15.0%in the four-pieces group,with no significant difference between the two groups(P>0.05).At 6 months after the operation,the incidence of dumping syndrome,intestinal obstruction and other recent complications was 13.0%in the three-pieces group and 10.0%in the four-pieces group,with no significant difference in the incidence of complications between the two groups(P>0.05).The 3-year survival rates of the three-pieces group and four-pieces group were 56.5%and 55.0%,There was no significant difference between the two groups(P>0.05).Conclusion In total laparoscopic distal radical gastrectomy first Cut off the duodenal and 4 straight line staple cartridge closures can be used for digestive tract reconstruction.The operation is easier to do and safe and reliable.