双通道吻合术与Roux-en-Y吻合术在腹腔镜近端胃癌根治术中的近期临床疗效对比

Comparison of short-term clinical efficacy of double tractanastomosis and Roux-en-Y anastomosis in laparoscopic assisted radical resection for proximal gastric cancer

目的探讨腹腔镜近端胃癌根治术中双通道消化道重建方式的近期临床效果。方法回顾性分析本院2016年1月至2018年12月收治的57例近端胃癌患者的临床资料,按照手术方式不同分为双通道组(空肠间置双通道吻合,n=27)和全胃组(全胃切除Roux-en-Y吻合,n=30)。比较两组手术指标、住院时间、住院费用、近期并发症发生率及术后不同时间体质量、血红蛋白水平、白蛋白水平。结果两组术中失血量、住院时间、住院费用、近期并发症发生率、体质量及白蛋白比较差异无统计学意义。双通道组手术时间为(249.6±38.8)min,短于全胃组的(278.5±46.2)min,淋巴结数目为(18.4±3.6)个,少于全胃组的(23.3±8.5)个,胃肠道生活质量指数评分为(102.0±6.5)分,高于全胃组的(84.9±8.2)分,差异均具有统计学意义(P<0.05)。术后1、3、6个月,双通道组血红蛋白水平高于全胃组,差异有统计学意义(P<0.05)。结论腹腔镜近端胃癌根治术采用双通道吻合的消化道重建方式具有良好的改善贫血效果,患者术后生活质量更好,在严格把握适应证的情况下可推广开展。

Objective To explore the short-term clinical efficacy of double tract digestive reconstruction in laparoscopy assisted radical gastrecto-my for proximal gastric cancer.Methods The clinical data of 57 patients with proximal gastric cancer treated in our hospital from January 2016 to December 2018 were retrospectively analyzed.They were divided into double tract group(double tract anastomosis between jejunum,n=27)and to-tal gastric group(total gastrectomy Roux-en-Y anastomosis,n=30)according to the operation method.The surgical indicators,hospitalization time,hospitalization expenses,recent complication rate,and body weight,hemoglobin level,and albumin level at different times after surgery were com-pared between the two groups.Results There was no significant difference in blood loss,hospital stay,hospitalization expenses,recent complication rate,body weight and albumin between the two groups.The operation time of the double tract group was(249.6±38.8)min,which was shorter than that of the total gastric group(278.5±46.2)min,the number of lymph nodes was(18.4±3.6),which was less than that of the total gastric group(23.3±8.5),the intestinal quality of life index scores was(102.0±6.5)scores,which was higher than the(84.9±8.2)scores of thet otal gastric group,the dif-ference was statistically significant(P<0.05).1,3,6 months after surgery,the hemoglobin level of the double tract group was higher than that of the total gastric group,the difference was statistically significant(P<0.05).Conclusions Double tract anastomosis for the digestive reconstruction has good effect of improving anemia in laparoscopic radical gastrectomy for proximal gastric cancer.Patients in double tract group postoperative has bet-ter quality of life than total gastrectomy group.The application should be promoted under the condition of adequate indications.