改良Roux-en-Y消化道重建在胃癌全胃切除术中的临床应用研究

Clinical application study of modified Roux-en-Y digestive tract reconstruction in total gastrectomy for gastric cancer

目的探讨胃癌患者改良Roux-en-Y吻合、Orr式Roux-en-Y吻合和Uncut式Roux-en-Y吻合3种全胃切除消化道重建术式的临床疗效。方法选取2016年1月至2021年9月收治于川北医学院附属南充市中心医院和川北医学院附属医院行腹腔镜胃癌D2根治术全胃切除消化道重建的胃癌患者145例作为研究对象,对其临床病例资料进行回顾性分析,其中54例行Orr式Roux-en-Y吻合(Orr组),48例行Uncut式Roux-en-Y吻合(Uncut组),43例行改良Roux-en-Y吻合(改良组)。统计分析3组患者的消化道重建时间、术中出血量、术后排气时间、术后禁食时间、术后住院时间、住院总费用、术后近远期并发症,以及术后1、3、6个月下降的体重和营养状况。结果3组患者的住院总费用、术中出血量、术后排气时间、术后禁食时间、术后住院时间比较差异无统计学意义(P>0.05)。Orr组的手术时间、消化道重建时间、术后住院时间均长于Uncut组和改良组,改良组消化道重建时间、手术时间均短于Orr组和Uncut组,差异均有统计学意义(P<0.05)。Uncut组和改良组近期并发症发生率均低于Orr组(P<0.05),但Uncut组和改良组近期并发症发生率比较差异无统计学意义(P>0.05);改良组的远期并发症发生率均低于Orr组和Uncut组,差异有统计学意义(P<0.05)。术后营养状况方面,Uncut组术后1个月体重下降值低于Orr组和改良组,但术后3、6个月,改良组体重下降值低于Orr组和Uncut组,差异均有统计学意义(P<0.05);Orr组术后1、3个月血红蛋白水平低于Uncut组和改良组(P<0.05),但术后6个月3组患者血红蛋白水平比较差异无统计学意义(P>0.05);3组术后1、3、6个月的血清总蛋白、血清白蛋白比较差异无统计学意义(P>0.05)。结论改良Roux-en-Y吻合在缩短消化道重建时间、减少术中出血、降低近远期并发症发生率、改善营养状况方面综合考虑更具优势。

Objective To investigate the clinical effects of three digestive tract reconstruction methods of the modified Roux-en-Y anastomosis,Orr Roux-en-Y anastomosis and Uncut Roux-en-Y anastomosis after total gastrectomy for gastric cancer.Methods From January 2016 to September 2021,a total of 145 patients with gastric cancer who underwent laparoscopic D2 radical gastrectomy for total gastrectomy and digestive tract reconstruction in Nanchong Central Hospital Affiliated to North Sichuan Medical College and Affiliated Hospital of North Sichuan Medical College were selected as the research objects,and their clinical case data were analyzed retrospectively.Among them,54 patients underwent Orr Roux-en-Y anastomosis(the Orr group),48 patients underwent Uncut Roux-en-Y anastomosis(the Uncut group)and 43 patients underwent modified Roux-en-Y anastomosis(the modified group).The digestive tract reconstruction time,intraoperative blood loss,postoperative exhaust time,postoperative fasting time,postoperative hospitalization time,total hos-pitalization expenses,short-term and long-term postoperative complications,and weight loss and nutritional status at 1,3 and 6 months after operation were statistically analyzed.Results There was no significant difference in total hospitalization expenses,intraoperative blood loss,postoperative exhaust time,postoperative fasting time and postoperative hospitalization time among the three groups(P>0.05).The operation time,digestive tract reconstruction time and postoperative hospitalization time in the Orr group were longer than those in the Uncut group and the modified group,the time of gastrointestinal reconstruction and surgery in the modified group were shorter than those in the Orr group and the Uncut group,and the differences were statistically significant(P<0.05).The incidence of recent complications in the Uncut group and the modified group was lower than that in the Orr group(P<0.05),but there was no statistical difference between the Uncut group and the modified group(P>0.05).The incidence of long-term complications in the modified group was lower than that in the Orr group and the Uncut group,and the difference was statistically significant(P<0.05).In terms of postoperative nutritional status,the weight loss of the Uncut group was lower than that of the Orr group and the modified group one month after operation,but the weight loss of the modified group was lower than that of the Orr group and the Uncut group three and six months after operation,and the difference was statistically significant(P<0.05).The hemoglobin level in the Orr group was lower than that in the Uncut group and the modified group at one and three months after operation(P<0.05),but there was no significant difference in hemoglobin level among the three groups at six months after operation(P>0.05).There was no significant difference in serum total protein and serum albumin between the three groups at 1,3 and 6 months after operation(P>0.05).Conclusion The modified Roux-en-Y digestive tract reconstruction has more advantages in shortening the time of digestive tract reconstruction,reducing intraoperative bleeding,reducing the incidence of short-term and long-term complications and improving nutritional status.