Ω形吻合在腹腔镜全胃切除术中的应用

Application ofΩ-shaped anastomosis in laparoscopic total gastrectomy

目的通过与Roux-en-Y吻合比较来评估Ω形吻合在腹腔镜全胃切除术中应用的安全性和可行性。方法采用回顾性队列研究的方法,收集在我院行腹腔镜全胃切除术的患者资料。根据消化道重建方式将患者分成Ω形吻合组(Ω组)和Roux-en-Y吻合组(R组),比较2组患者手术时间、吻合时间、通气时间、术后住院时间、吻合费用及并发症发生情况,并对2组患者进行随访以评估其术后生活质量。结果与R组比较,Ω组的手术时间及吻合时间更短,通气时间更早,吻合费用更少,差异均具有统计学意义(P<0.05)。2组患者的术后住院时间及术后并发症的发生率比较,差异均无统计学意义(P>0.05)。术后第6个月,EORTC-QLQ-C30量表显示,Ω组的总体健康状况评分高于R组,恶心呕吐症状评分低于R组,差异均具有统计学意义(P<0.05);2组其余功能领域及症状领域评分比较,差异均无统计学意义(P>0.05)。EORTC-QLQ-STO22量表显示,Ω组的反流症状领域评分低于R组,差异具有统计学意义(P<0.05);2组其余症状领域评分比较,差异均无统计学意义(P>0.05)。结论Ω形吻合用于重建腹腔镜全胃切除后消化道的连续性是安全可行的,并且能够提高患者术后生活质量。

Objective To evaluate the safety and feasibility ofΩ-shaped anastomosis in laparoscopic total gastrectomy by comparing it with Roux-en-Y anastomosis.Methods A retrospective cohort study was used to collect the clinical data of patients undergoing laparoscopic total gastrectomy in our hospital.These patients were divided into theΩ-shaped anastomosis group(theΩgroup)and the Roux-en-Y anastomosis group(the R group)according to the way of digestive tract reconstruction.The operation time,anastomosis time,anal exhaust time,postoperative hospital stay,anastomosis cost and complications of the two groups were compared,and the patients in the two groups were followed up to evaluate their postoperative quality of life.Results Compared with the R group,the operation time and anastomosis time were shorter,the anal exhaust time was earlier,and the anastomosis cost was less in theΩgroup,and the differences were all statistically significant(P<0.05).There were no significant differences in postoperative hospital stay or incidence of postoperative complications between the two groups(P>0.05).At 6 months after operation,the EORTC-QLQ-C30 scale showed that the score of general health in theΩgroup was higher than that in the R group,and the score of nausea and vomiting symptom in theΩgroup was lower than that in the R group,and the differences were statistically significant(P<0.05).There were no significant differences in the scores of other functional areas and symptomatic areas between the two groups(P>0.05).The EORTC-QLQ-STO22 scale showed that the score of reflux symptom in theΩgroup was lower than that in the R group,and the difference was statistically significant(P<0.05).There were no significant differences in the scores of other symptomatic areas between the two groups(P>0.05).Conclusion TheΩ-shaped anastomosis is safe and feasible to reconstruct the continuity of digestive tract after laparoscopic total gastrectomy,and it can improve the postoperative quality of life of patients.