不同胃肠吻合方式在全3D腹腔镜远端胃切除术后消化道重建中的应用

Application of different gastrointestinal anastomosis methods in gastrointestinal reconstruction after 3D laparoscopic distal gastrectomy

目的探讨不同胃肠吻合方式在胃癌患者全3D腹腔镜远端胃切除术后消化道重建中的应用价值。方法选取2019年2月至2021年2月江苏无锡江南大学附属医院收治的142例进展期胃癌患者,均行全3D腹腔镜远端胃切除术,根据消化道重建方式的不同分为R组(76例,行非离断式Roux-en-Y吻合术)和B组(66例,行BillrothⅡ式吻合术)。比较两组的围术期相关指标、术后1年的营养指标及生活质量(采用Visick分级进行评估)、术后并发症发生情况等。结果与B组相比,R组的消化道重建时间更长,术后肛门排气时间及术后住院时间更短(P<0.05),而两组的术中出血量、术后首次进食时间比较差异无显著性(P>0.05)。术后1年时,R组的预后营养指数(prognostic nutritional index,PNI)明显高于B组,生活质量明显优于B组(Visick分级Ⅰ级占比更高,Ⅳ级占比更低),差异均有显著性(P<0.05)。R组术后胆汁反流、倾倒综合征、反流性胃炎等并发症发生率均明显低于B组,差异有显著性(P<0.05)。结论与BillrothⅡ式吻合相比,胃癌患者行全3D腹腔镜远端胃切除术后采用非离断式Roux-en-Y吻合进行消化道重建虽然手术时间较长,但其并发症发生率更低,胃肠功能恢复更快,有助于改善术后生活质量。

Objective To explore the application value of different gastrointestinal anastomosis methods in the reconstruction of gastrointestinal tract after full 3D laparoscopic distal gastrectomy in patients with gastric cancer.Method Total of 142 patients with advanced gastric cancer in our hospital were treated with 3D laparoscopic distal gastrectomy.According to the different reconstruction methods of digestive tract,76 patients were treated with Roux-en-Y non disconnection anastomosis(group R)and 66 patients with BillrothⅡanastomosis(group B).The time of digestive tract reconstruction,intraoperative bleeding,gastrointestinal function recovery,nutrition,complications and quality of life were compared between the two groups.Result Compared with group B,the digestive tract reconstruction time in group R was longer,the anal exhaust time and the hospital stay after operation were shorter(P<0.05).There was no significant difference between the two groups in the amount of bleeding during operation and the time of first eating after operation(P>0.05).Compared with group B,the level of PNI in group R was higher one year after operation,and the incidence of bile reflux,dumping syndrome and reflux gastritis was lower in group R(P<0.05).There was a statistically significant difference between the two groups in the Visick grading index one year after operation(P<0.05).The proportion of Grade I in Group R was higher,and that of Grade IV was lower.Conclusion Compared with BillrothⅡanastomosis,Roux-en-Y anastomosis is used for gastrointestinal reconstruction in patients with gastric cancer after full 3D laparoscopic distal gastrectomy.Although the operation time is longer,the incidence of complications is lower,gastrointestinal function recovery is faster,and it is helpful to improve the quality of life of patients after surgery.