全腹腔镜全胃切除术食管空肠overlap吻合与π形吻合的安全性及有效性分析

Analysis of the Safety and Effectiveness of Overlap andπ-shaped Esophagojejunostomy in Total Laparoscopic Gastrectomy

目的探讨全腹腔镜全胃切除术行食管空肠overlap吻合与π形吻合的安全性及有效性。方法回顾性收集2016年10月~2020年1月徐州医科大学附属医院普外科收治的95例行全腹腔镜全胃切除术患者的临床资料,根据术中食管空肠吻合方式的不同,分overlap吻合组(n=41)与π形吻合组(n=54)。统计两组在术中、术后及吻合口相关并发症以及随访指标(反流性食管炎、倾倒综合征、吻合口溃疡)的发生情况。结果两吻合组中,overlap吻合与π形吻合组手术总时间分别为248.5±44.6min、23S±40.2min;吻合时间分别为24.5±4.2min、18.7±3.5min;术中出血量分别为174.5±53.1ml、162.9±34.3ml;术后首次下床活动时间分别为25.0±3.1h、26.1±2.7h;术后首次肛门排气时间分别为3.6±1.0天、3.7±1.0天;术后首次进食流质饮食时间分别为5.5±1.1天、5.1±1.1天;术后住院天数分别为10.3±1.3天、10.6±1.5天。吻合口相关并发症方面,overlap吻合与π形吻合组的吻合口出血、吻合口漏和吻合口狭窄的发生率分别为0、4.9%、2.4%、3.7%、1.9%和7.4%。在随访指标中,overlap吻合与π形吻合组的反流性食管炎、倾倒综合征、吻合口溃疡发生率分别为5.0%、7.5%、2.5%、3.8%、9.4%和3.8%。结论全腹腔镜全胃切除术食管空肠overlap吻合与π形吻合均安全、可行。

Objective To explore the safety and effectiveness of overlap andπ-shaped anastomosis in total laparoscopic gastrectomy(TLTG).Methods We retrospectively collectted the clinical data of 95 patients undergoing TLTG who were admitted to the Department of General Surgery of the Affiliated Hospital of Xuzhou Medical University from October 2016 to January 2020.According to the different ways of esophagojejunostomy,they were divided into overlap group(n=41)andπ-shaped group(n=54).Statistics of the occurrence of complications during the intraoperative,postoperative and anastomotic complications and the follow-up indicators(reflux esophagitis,dumping syndrome,anastomotic ulcer)of the two groups.Results The total operation time of overlap anastomosis andπ-shaped anastomosis groups were 248.5±44.6min and 233.6±40.2min.The anastomosis time were 24.5±4.2min and 18.7±3.5min.The intraoperative blood loss were 174.5±53.1ml and 162.9±34.3ml.The first ambulation time were 25.0±3.1h and 26.1±2.7h.The first exhaust time were 3.6±1.0days and 3.7±1.0days.The first liquid diet time were 5.5±1.1days and 5.1±1.1days.The postoperative hospital stay were 10.3±1.3days,10.6±1.5days.In terms of anastomotic-related complications,the incidences of anastomotic bleeding,anastomotic leakage,and anastomotic stenosis of overlap anastomosis andπ-shaped anastomosis groups were 0,4.9%,2.4%,3.7%,1.9%and 7.4%,respectively.In the follow-up indicators,the incidence of reflux esophagitis,dumping syndrome,and anastomotic ulcers were 5.0%,7.5%,2.5%,3.8%,9.4%and 3.8%,respectively.Conclusion The overlap anastomosis andπ-shaped anastomosis are both safe and feasible in TLTG.