不同消化道重建方式在腹腔镜保留幽门胃切除术的临床效果对比研究

Comparative study on the clinical effect of different digestive tract reconstruction methods in laparoscopic pylorus-preservinggastrectomy

目的探讨并对比腔内Delta吻合、穿刺法端端吻合及Overlap吻合在腹腔镜保留幽门胃切除术(LAPPG)的临床应用效果。方法回顾性分析2018年1月至2021年6月接受LAPPG的90例早期胃癌患者的临床资料。根据消化道重建方式不同分为A组(行腔内Delta吻合)、B组(行Overlap吻合)和C组(行穿刺法端端吻合),每组各30例。采用SPSS24.0进行数据分析,围手术期相关指标和营养学指标等计量资料采用(x±s)表示,多组间比较采用单因素方差分析法,组间两两比较采用独立样本t检验;不同时间点营养学指标采用重复测量方差分析;术后并发症等计数资料采用χ^(2)检验。P<0.05为差异有统计学意义。结果A组患者术后肛门恢复排气时间及住院时间长于C组(P<0.05);三组患者手术时间、吻合时间、术中出血量及术后残余胃量比较差异均无统计学意义(P>0.05)。三组患者术后并发症总发生率比较差异无统计学意义(P>0.05)。三组患者组内比较术后3d、7d血液白细胞计数均高于术前,血清白蛋白与血红蛋白均低于术前(P<0.05);三组患者组间比较,C组患者术后3d、7d血清白蛋白水平和血红蛋白水平高于A、B两组(P<0.05)。结论穿刺法端端吻合在腹腔镜保留幽门胃切除术中具有安全可行、术后恢复快和住院时间短等优点,值得临床推广应用。

Objective To investigate the clinical effect of Delta anastomosis,end-to-end puncture anastomosis and Overlap anastomosis in laparoscopice pylorus-preserving gastrectomy(LAPPG).MethodsThe clinical data of 90 patients with early gastric cancer who received LAPPG from January 2018 to June 2021 were retrospectively analyzed.According to the different reconstruction methods of digestive tract,the patients were divided into group A(Delta anastomosis),group B(Overlap anastomosis)and group C(end-to-end anastomosis by puncture),with 30 cases in each group.SPSS 24.0 was used for data analysis.Perioperative indicators and nutritional indicators were expressed by(x+s).One-way ANOVA was used for comparison between groups,and independent sample t-test was used for pairwise comparison between groups.Nutrition indexes at different time points were analyzed by repeated measures ANOVA.Postoperative complications and other counting data were analyzed by χ^(2) test.P<0.05 was considered statistically significant.ResultsThe postoperative anal recovery time and hospital stay of group A were longer than those of group C(P<0.05).There were no significant dfferences in operation time,anastomosis time,intraoperative blood loss and postoperative residual stomach volume among the three groups(P>0.05).There was no significant difference in the total incidence of postoperative complications among the three groups(P>0.05).The white blood cell count on the 3rd and 7th day after operation was higher than that before operation,and the serum albumin and hemoglobin were lower than those before operation(P<0.05).Compared among the three groups,the serum albumin and hemoglobin levels in group C were higher than those in groups A and B on the 3rd and 7th day after operation(P<0.05).Conclusion End to end anastomosis by puncture in laparoscopic pylorus-sparing gastrectomy has the advantages of safe,feasible,quick postoperative recovery and short hospital stay,which is worthy of clinical application.