非离断式Roux-en-Y吻合在远端胃癌D2根治术中的临床应用

Clinical application of uncut Roux-en-Y anastomosis in radical D2 resection for distal gastric cancer

目的探讨非离断式Roux-en-Y吻合方式在远端胃癌D2根治术中的临床应用价值。方法纳入在广东省海丰县彭湃纪念医院行远端胃癌D2根治术患者50例,按照不同的消化道重建方式分为试验组(非离断式Roux-en-Y吻合)和对照组(传统Roux-en-Y吻合),每组各25例。分别比较两组病例的消化道重建及肛门恢复排气时间,术后吻合口/残端漏、吻合口炎/溃疡和Roux-en-Y滞留综合征等的发生率。结果试验组消化道重建时间和肛门恢复排气时间分别为(46.92±4.31)min、(50.52±4.50)h,对照组分别为(50.32±4.65)min、(53.76±4.35)h,差异有统计学意义(P<0.05)。试验组2例发生Roux-en-Y滞留综合征,而对照组为10例,差异有统计学意义(P<0.05)。在吻合口/残端漏、吻合口炎/溃疡方面,两组差异无统计学意义(P>0.05)。结论非离断式Roux-en-Y吻合用于远端胃癌D2根治术可以缩短术中消化道重建时间,同时减少Roux-en-Y滞留综合征发生率。

Objective To explore the value of uncut Roux-en-Y gastrointestinal reconstruction in D2 radical resection of distal gastric cancer.Methods Fifty patients who underwent D2 radical resection of distal gastric cancer in our hospital were enrolled,and were divided into two groups(uncut Roux-en-Y anastomosis)and control group(conventional Roux-en-Y anastomosis),25 cases in each group.The gastrointestinal reconstruction time and time to initial anal exhaust,postoperative anastomotic/stump leakage,anastomotic stomatitis/ulcer and Roux-en-Y stasis syndrome were compared between the two groups.Results The gastrointestinal reconstruction time and the time to initial anal exhaust of the uncut Roux-en-Y group were(46.92±4.31)min and(50.52±4.50)h,respectively,while,the control group were(50.32±4.65)min and(53.76±4.35)h,respectively.The difference was statistically significant(P<0.05).Roux-en-Y stasis syndrome occurred in 2 cases in the uncut group,and 10 cases in the control group(P<0.05).In terms of anastomotic/stump leakage,anastomotic stomatitis/ulcer,the difference between the two groups was not statistically significant(P>0.05).Conclusion Uncut Roux-en-Y anastomosis for D2 radical resection of distal gastric cancer can shorten the time of gastrointestinal reconstruction during operation and reduce the incidence of Roux-en-Y stasis syndrome.