全腹腔镜远端胃癌根治术中胃肠吻合共同开口关闭方式的对比研究

Comparative study of common opening closure methods in gastrointestinal anastomosis during totally laparoscopic radical gastrectomy for distal gastric cancer

目的:探讨完全腹腔镜远端胃癌根治术中胃肠吻合共同开口两种不同闭合方式的可行性、安全性及经济性。方法:回顾分析2016年1月至2020年12月行完全腹腔镜远端胃癌根治术+毕Ⅱ式、Braun吻合的331例患者的临床资料,其中152例使用直线切割闭合器关闭共同开口(闭合器组),179例采用免打结可吸收倒刺线(KBAS)连续缝合关闭共同开口(KBAS组),对比分析两组操作便利性、术后并发症发生率、肛门排气时间及手术耗材费用等指标。结果:KBAS组与闭合器组手术时间[(142.2±27.1)min vs.(146.7±26.5)min,P=0.13]、术后住院时间[(7.2±2.9)d vs.(7.5±3.5)d,P=0.39]差异无统计学意义,共同开口闭合时间[(8.9±2.5)min vs.(6.6±3.4)min,P<0.01]、术后排气时间[(3.03±0.79)d vs.(2.85±0.53)d,P=0.02]、关闭共同开口耗材使用费用[(1304.5±24.0)元vs.(1690.3±195.7)元,P<0.01]差异有统计学意义。闭合器组与KBAS组术后吻合口漏发生率[2.0%(3/152)vs.1.7%(3/179),P=0.83]、术后吻合口轻微梗阻发生率[2.0%(3/152)vs.0.6%(1/179),P=0.51]差异无统计学意义;闭合器组1例术后发生切割缘出血;两组总体术后并发症发生率[4.6%(7/152)vs.2.2%(4/179),P=0.25]差异无统计学意义。结论:全腹腔镜远端胃癌根治术中,应用KBAS连续缝合或线性切割闭合器关闭共同开口术后发生吻合口漏、出血及梗阻等风险均较低,术后恢复时间相近,均可作为胃肠吻合后共同开口闭合的选择方案。

Objective:To investigate the feasibility,safety and economy of two different closure methods of the common opening in totally laparoscopic distal gastrectomy for gastric cancer.Methods:A retrospective analysis was performed on the clinical data of 331 patients who underwent totally laparoscopic distal gastrectomy+BillrothⅡplus Braun anastomosis from Jan.2016 to Dec.2020,including 152 cases in the linear stapler group and 179 cases in the knotless barbed absorbable sutures(KBAS)group.The operation convenience,postoperative complication incidence,anus exhausting time and cost of surgical consumable were compared between the two groups.Results:The average operation time in the KBAS group and linear stapler group was[(142.2±27.1)min vs.(146.7±26.5)min,P=0.13],the average closing time of the common opening was[(8.9±2.5)min vs.(6.6±3.4)min,P<0.01],the average time to first flatus was[(3.03±0.79)d vs.(2.85±0.53)d,P=0.02],the average postoperative hospital stay was[(7.2±2.9)d vs.(7.5±3.5)d,P=0.39],the consumable cost for common opening closure was[(1304.5±24.0)vs.(1690.3±195.7)yuan,P<0.01].The incidence of postoperative anastomotic leakage in the linear stapler group and the KBAS group was 2.0%(3/152)and 1.7%(3/179)respectively(P=0.83).The incidence of minor anastomotic obstruction in the two groups was[2.0%(3/152)vs.0.6%(1/179),P=0.51].In addition,there was one case of postoperative cutting edge bleeding in the linear stapler group.The overall incidence of postoperative complications in the two groups was[4.6%(7/152)vs.2.2%(4/179),P=0.25].Conclusions:In totally laparoscopic radical resection of distal gastric cancer,the risk of anastomotic leakage,bleeding and obstruction after closing the common opening with linear stapler or KBAS continuous suture is low.The postoperative recovery time is similar,both methods can be choices for closing the common opening after gastrointestinal anastomosis.