腹腔镜远端胃癌根治术后三种消化道重建方式的疗效分析

Efficacy Analysis of Three Methods of Digestive Tract Reconstruction in Laparoscopic Distal Gastrectomy for Gastric Cancer

目的:比较三种消化道重建方式在腹腔镜胃癌根治远端胃切除术中的效果。方法:回顾性分析2019年1月-2021年1月长治医学院附属和平医院收治的86例胃癌患者的临床资料。按照不同消化道重建方法分为A组(n=26,Billroth-Ⅱ吻合)、B组(n=36,胃空肠Roux-en-Y吻合)、C组(n=24,Uncut Roux-en-Y吻合)。比较三组手术时间、消化道重建时间、术中出血量、肛门排气时间、进食时间、术后住院时间及术后并发症情况[吻合口瘘、吻合口出血、胆汁反流、反流性食管炎、反流性胃炎、胃潴留、肠梗阻、ROUX淤滞综合征(roux stasis syndrome,RSS)]。结果:三组术后肛门排气时间、进流食时间比较,差异均有统计学意义(P<0.05);C组术后肛门排气时间、进流食时间均短于A组,且术后肛门排气时间短于B组(P<0.05)。C组与B组胆汁反流、反流性胃炎发生率均低于A组,C组RSS发生率低于B组(P<0.05)。三组手术时间、消化道重建时间、术中出血量、术后住院时间及吻合口瘘、出血、反流性食管炎、肠梗阻、胃潴留发生率比较,差异均无统计学意义(P>0.05)。结论:在腹腔镜胃癌根治远端胃切除术中行Uncut-Roux-en-Y吻合可以减少术后并发症,加快胃肠功能恢复,是一个相对更安全、可靠的术式,因此值得推荐。

Objective:To compare the therapeutic effects of three methods of digestive tract reconstruction in laparoscopic distal gastrectomy for gastric cancer.Method:The clinical data of 86 patients with gastric cancer treated in Heping Hospital Affiliated to Changzhi Medical College from January 2019 to January 2021 were analyzed retrospectively.The patients were divided into three groups according to different digestive tract reconstruction methods,including group A(n=26,Billroth-Ⅱ anastomosis),group B(n=36,Roux-en-Y anastomosis)and group C(n=24,Uncut Roux-en-Y anastomosis).The surgery time,digestive tract reconstruction time,bleeding during surgery,anal exhaust time,fluid feeding time,postoperative hospital stay and postoperative complications[anastomotic fistula,anastomotic bleeding,bile reflux,reflux esophagitis,reflux gastritis,gastric retention,intestinal obstruction,Roux stasis syndrome(RSS)]among three groups were compared.Result:There were statistically significant differences in postoperative anal exhaust time and fluid feeding time among three groups(P<0.05);the postoperative anal exhaust time and fluid feeding time in group C were shorter than those in group A,and the postoperative anal exhaust time was shorter than that in group B(P<0.05).The incidences of bile reflux and reflux gastritis in group C and group B were lower than those in group A,and the incidence of RSS in group C was lower than that in group B(P<0.05).There were no significant differences in operation time,digestive tract reconstruction time,intraoperative blood loss,postoperative hospital stay,the incidence rates of anastomotic fistula,bleeding,reflux esophagitis,intestinal obstruction and gastric retention among three groups(P>0.05).Conclusion:Uncut Rouxen-Y anastomosis in digestive tract reconstruction in laparoscopic distal gastrectomy for gastric cancer can reduce postoperative complications and accelerate gastrointestinal function recovery,which is a relatively safer and more reliable operation,so it is worthy of recommendation.