腹腔镜辅助远端胃癌根治术不同Uncut Roux-en-y吻合方式对病人的疗效及对肿瘤标志物和预后的影响

Evaluation of the efficacy of different Uncut Roux-en-y surgical approaches in patients with gastric cancer and the impact on their test indicators and prognosis

目的探讨不同Uncut Roux-en-y吻合方式对胃癌病人的疗效及对其检验指标和预后的影响。方法我院2018年3月~2021年2月收治的远端胃癌病人96例,均行腹腔镜辅助远端胃癌根治术,根据吻合方式分为两组,其中研究组46例,采用改良U-RY吻合术治疗,对照组病人50例,采用U-RY吻合术治疗,比较两组病人的围术期指标(手术时间、术中出血量、首次通气时间、住院时间及术后第1天引流量)、手术前后肿瘤相关指标(CEA、CA19-9)、术后并发症及术后1年的预后情况。结果除术后第1天引流量外,研究组的其余指标(手术时间、术中出血量、首次通气时间和住院时间)优于对照组(P<0.05);术前两组的肿瘤相关指标(CA19-9、CEA)比较无明显差异(P>0.05),术后两组病人的肿瘤相关指标(CA19-9、CEA)均较术前降低,差异有统计学意义(P<0.05);研究组总并发症发生率比对照组低(8.7%vs 30.0%,P<0.05);术后1年,两组病人的生存率和复发率比较无明显差异(97.8%vs 96.0%,4.3%vs 6.0%,P>0.05)。结论腹腔镜辅助远端胃癌根治术中应用改良U-RY吻合术可显著缩短病人的手术时间,加快病人的康复速度,且可降低其术后并发症发生率,最终不影响病人的预后。

Objective To investigate the efficacy of different Uncut Roux-en-y surgical approaches on patients with gastric cancer and the effect on their test indicators and prognosis.Methods 96 patients with distal gastric cancer admitted to our hospital from March 2018 to February 2021 received laparoscopic assisted radical gastrectomy for distal gastric cancer.According to surgical methods,96 patients were divided into 2 groups.Among them,46 patients in the study group were treated with modified U-RY anastomosis,while 50 patients in the control group were treated with U-RY anastomosis.Perioperative indicators(operation time,intraoperative blood loss,first ventilation time,hospital stay and drainage volume on the first day after operation),tumor-related indicators(CEA,CA199)before and after operation,postoperative complications and prognosis one year after operation were compared between the two groups.Results Except for the drainage volume on the first day after surgery,the other indexes(operation time,intraoperative blood loss,first ventilation time and hospital stay)of the study group were better than those of the control group(P<0.05).The tumor-related indexes(CA199,CEA)were not different between the two groups before surgery(P>0.05),while the tumor-related indexes(CA199,CEA)were lower in both groups after surgery compared with those before surgery(P<0.05);after surgery,the overall complication rate was lower in the study group than in the control group(8.7%vs.30.0%,P<0.05);one year after surgery,there was no difference in the survival and recurrence rates between the two groups(97.8%vs.96.0%;4.3%vs.6.0%;P>0.05).Conclusion The application of modified U-RY anastomosis in LADG significantly shortens the operative time of patients,accelerates their recovery,and reduces their postoperative complication rate,which ultimately does not affect their prognosis.