胃十二指肠手工吻合在完全腹腔镜远端胃切除术中的应用价值

Application value of manual anastomosis of gastroduodenum in totally laparoscopic distal gastrectomy

目的探讨胃十二指肠手工吻合在完全腹腔镜远端胃切除术中的应用价值。方法采用回顾性队列研究方法。收集2020年1月至2022年10月天津医科大学肿瘤医院收治的55例行完全腹腔镜远端胃癌根治性切除+胃十二指肠吻合术患者的临床病理资料;男34例,女21例;年龄为61(29~75)岁。55例患者中,25例消化道重建行胃十二指肠手工吻合,设为手工吻合组;30例消化道重建行胃十二指肠改良Delta吻合,设为改良Delta吻合组。观察指标:(1)手术情况。(2)术后并发症情况。正态分布的计量资料以x^(-)±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。结果(1)手术情况。55例患者均顺利施行手术,无中转开腹。手工吻合组和改良Delta吻合组患者肿瘤上缘距上切缘距离、吻合时间、使用钉仓数目分别为(48±4)mm、(22.6±2.3)min、(3.2±0.5)枚和(41±4)mm、(14.0±1.4)min、(5.2±0.4)枚,两组患者上述指标比较,差异均有统计学意义(t=5.04,16.38,-17.13,P<0.05);肿瘤部位(胃窦、胃角)分别为18、7例和29、1例,两组上述指标比较,差异有统计学意义(P<0.05)。(2)术后并发症情况。手工吻合组和改良Delta吻合组患者均未发生吻合口瘘,改良Delta吻合组患者发生1例吻合口狭窄。结论与胃十二指肠改良Delta吻合比较,完全腹腔镜远端胃切除术中行胃十二指肠手工吻合可切除更多胃组织,使用吻合器钉仓数目更少。

Objective To investigate the application value of manual anastomosis of gastro-duodenum in totally laparoscopic distal gastrectomy.Methods The retrospective cohort study was conducted.The clinicopathological data of 55 patients with gastric cancer who underwent totally laparoscopic distal gastrectomy combined with gastrointestinal anastomosis in the Tianjin Medical University Cancer Institute&Hospital from January 2020 to October 2022 were collected.There were 34 males and 21 females,aged 61(range,29-75)years.Of 55 patients,25 patients undergoing manual anastomosis of gastroduodenum were divided into the manual anastomosis group,30 patients undergoing modified Delta anastomosis of gastroduodenum were divided into the modified Delta anastomosis group.Observation indicators:(1)surgical situations;(2)postoperative complications.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers,and comparison between groups was conducted using chi-square test or Fisher exact probility.Results(1)Surgical situations.All 55 patients underwent surgery successfully,without conversion to laparotomy.The distance from the superior margin of tumor to the upper margin,anastomosis time,number of bookings used were(48±4)mm,(22.6±2.3)minutes,3.2±0.5 in the manual anastomosis group,versus(41±4)mm,(14.0±1.4)minutes,5.2±0.4 in the modified Delta anastomosis group,showing significant differences in the above indicators between the two groups(t=5.04,16.38,-17.13,P<0.05).The location of tumor(antrum,gastric angle)was 18,7 in the manual anastomosis group,versus 29,1 in the modified Delta anastomosis group,showing a significant difference between the two groups(P<0.05).(2)Postoperative complications.There was no patient undergoing anastomotic fistula in both of manual anastomosis group and modified Delta anastomosis group,and there was 1 patient undergoing anastomotic stenosis in the modified Delta anastomosis group.Conclusion Compared with modi-fied Delta anastomosis of gastroduodenum,totally laparoscopic distal gastrectomy with manual anas-tomosis of gastroduodenum can remove more gastric tissue,and decrease the number of bookings used.