胃空肠裤形吻合与毕Ⅰ式吻合术在腹腔镜远端胃癌根治术中的应用效果对比

Comparison of Therapeutic Effect Between Gastrojejunal Trouser Shaped Anastomosis and BiⅠType Anastomosis in Laparoscopic Distal Gastrectomy for Gastric Cancer

目的比较胃空肠裤形吻合与毕Ⅰ式吻合术在腹腔镜远端胃癌根治术中的应用效果及安全性。方法选取2019年1月至2022年1月在平煤神马医疗集团总医院接受腹腔镜远端胃癌根治术的90例患者,根据消化道重建方式为裤形吻合组(43例)和毕Ⅰ式吻合组(47例)。比较两组围手术期相关指标,术后1、2、3 d的视觉模拟评分法(VAS)评分以及胃镜RGB分级、胃镜洛杉矶分级、生活质量和并发症发生情况。结果裤形吻合组手术时间、术后排气时间、住院时间短于毕Ⅰ式吻合组(P<0.05),裤形吻合组术中出血量、淋巴结清扫数目少于毕Ⅰ式吻合组(P<0.05)。术后1、2 d裤形吻合组VAS评分低于毕Ⅰ式吻合组(P<0.05)。裤形吻合组术后6、12个月,食物残留、胃炎、胆汁反流的胃镜RGB分级≥1级率均低于毕Ⅰ式吻合组(P<0.05)。裤形吻合组术后6、12个月胃镜洛杉矶分级≥A级率分别为23.26%、23.26%,低于毕Ⅰ式吻合组的44.68%、48.94%(P<0.05)。裤形吻合组术后6、12个月生活质量优于毕Ⅰ式吻合组(P<0.05)。结论胃空肠裤形吻合应用于腹腔镜远端胃癌根治术中,可有效缩短手术时间和住院时间,减少术中出血,且可有效改善术后胆汁反流的问题,提高术后生活质量,且安全性高。

Objective To compare the therapeutic effect and safety of gastrojejunal trouser shaped anastomosis and BiⅠtype anastomosis in laparoscopic distal gastrectomy for gastric cancer.Methods A total of 90 patients who underwent laparoscopic distal gastrectomy for gastric cancer in Pingmei Shenma Medical Group General Hospital from January 2019 to January 2022 were selected.According to the reconstruction method of the digestive tract,patients were divided into the trouser shaped anastomosis group(43 cases)and the BiⅠtype anastomosis group(47 cases).Perioperative related indicators,visual analogue scale(VAS)scores on the 1st,2nd,and 3rd postoperative days,as well as gastroscopy RGB grading,gastroscopy Los Angeles grading,quality of life and incidence of complications of two groups were compared.Results The surgical time,postoperative exhaust time and hospitalization time of the trouser shaped anastomosis group were shorter than those of the BiⅠtype anastomosis group(P<0.05),while the intraoperative bleeding and lymph node dissection number of the trouser shaped anastomosis group were lower than those of the BiⅠtype anastomosis group(P<0.05).The VAS scores of the trouser shaped anastomosis group were lower than those of the BiⅠtype anastomosis group on the 1st and 2nd day after surgery(P<0.05).The postoperative rates of food residue and gastroscopy,gastritis and gastroscopy,bile reflux and gastroscopy RGB grading≥1 grade in the trouser shaped anastomosis group were lower than those in the BiⅠtype anastomosis group(P<0.05).The rates of gastroscopy Los Angeles grade≥A in the trouser shaped anastomosis group at 6 and 12 months after surgery were 23.26%and 23.26%,respectively,which were lower than the BiⅠtype anastomosis group(44.68%and 48.94%)(P<0.05).The quality of life of the trouser shaped anastomosis group at 6 and 12 months after surgery was better than that of the BiⅠtype anastomosis group(P<0.05).Conclusion The application of gastrojejunal trouser shaped anastomosis in laparoscopic distal gastric cancer radical surgery can effectively shorten the surgical time and hospitalization time,reduce intraoperative bleeding,and improve postoperative bile reflux,improve postoperative quality of life,and have high safety.