腹腔镜下近端胃切除双通道消化道重建食管空肠“π”形吻合与端侧吻合短期疗效对比研究

A comparative study of short-term outcomes between the double-tract reconstruction combined withπ-shaped and circular esophagojejunal anastomosis after laparoscopic proximal gastrectomy

目的探讨腹腔镜下近端胃切除(LPG)双通道消化道重建(DTR)食管空肠“π”形吻合与端侧吻合的短期疗效对比研究。方法回顾性分析2021年1月至2021年10月在解放军总医院第一医学中心普通外科医学部接受LPG双通道重建食管空肠“π”形吻合病人23例(“π”形吻合组)以及食管空肠端侧吻合病人25例(端侧吻合组)资料,所有病人均诊断食管胃结合部腺癌。两组病人均常规行LPG、D2淋巴结清扫及DTR,“π”形吻合组应用直线切割闭合器在腹腔镜下完成食管空肠“π”形吻合,端侧吻合组应用圆形吻合器经上腹部辅助切口直视下完成食管空肠端侧吻合。比较两组病人的基本资料、手术相关及围手术期指标、并发症发生率和术后炎症指标,以评价食管空肠“π”形吻合术的短期疗效。结果相比于端侧吻合组,“π”形吻合组手术切口更短,差异有统计学意义(P<0.01),在手术时间、术中出血量、术后排气时间、术后住院时间、手术费用以及淋巴结清扫数目等方面差异均无统计学意义(P>0.05)。两组病人在术后1 d、3 d、5 d血红蛋白水平、白细胞计数、中性粒细胞计数以及C反应蛋白水平等差异均无统计学意义(P>0.05)。所有病人顺利出院,无围术期死亡,“π”形吻合组围手术期内出现术后麻痹性肠梗阻、感染性肺炎和胸腔积液各1例,端侧吻合组出现感染性肺炎2例、胸腔积液2例、麻痹性肠梗阻1例,Clavien-Dindo分级均为Ⅱ级,予以保守治疗痊愈,无手术相关死亡,两组并发症发生率差异无统计学意义(P>0.05)。结论LPG双通道重建食管空肠“π”形吻合术手术安全可行,近期疗效满意,简化了吻合步骤,病人手术切口更短、腹部美观度好,不增加术后并发症风险,值得临床推广。

Objective withπ-shaped and circular esophagojejunal anastomosis after laparoscopic proximal gastrectomy(LPG).MethodsThe clinical data of 48 patients with adenocarcinoma of the esophagogastric junction(AEG)from January 2021 to October2021 who underwent LPG were retrospectively analyzed.They were divided intoπ-shaped esophagojejunal anastomosis group(π-shaped group)and circular esophagojejunal anastomosis group(circular group).The clinical data were compared between the two groups.Results Compared with the circular group,theπ-shaped group permits the shorter length of incision(P<0.01).Still,there were no statistically significant differences in operation time,intraoperative blood loss,postoperative exhaust time,postoperative hospital stay,surgical cost,and the number of lymph node dissections(P>0.05).There were no significant differences in hemoglobin levels,white blood cell counts,neutrophil counts and C-reactive protein levels between the two groups(P>0.05).All patients were discharged fromthe hospital.In theπ-shaped group,1 case ofpostoperative paralytic intestinal obstruction,pleuraleffusion and infectious pneumonia occurred duringthe perioperative period.In the circular group,2 casesof infectious pneumonia,1 case of postoperative paralytic intestinal obstruction and 2 cases of pleural effusion occurred.The Clavien-Dindo classification was both gradeⅡ.There was no surgery-related death,and there was no statistically significant difference in the incidence ofcomplications between the two groups(P>0.05).ConclusionThe DTR combined withπ-shaped esophagojejunalanastomosis after LPG is safe and feasible.It can simplify anastomosis procedure,provide shorter length of the incisionand good clinical effect,do not increase the risk of postoperative complications.Preliminary observations show that theDTR combined withπ-shaped esophagojejunal anastomosis after LPG has good potential for clinical application in thefuture.