全腹腔镜全胃切除术食管空肠π形吻合与overlap吻合临床效果比较

Effect comparison of π-shaped and overlap esophagojejunostomy in totally laparoscopic total gastrectomy

目的探讨食管空肠π形吻合与overlap吻合行全腹腔镜全胃切除术后消化道重建的临床效果。方法选取2018年6月至2021年6月在我院行全腹腔镜全胃切除术的102例胃癌患者行回顾性分析,按消化道重建吻合方式分为π形吻合组及overlap吻合组,各51例。比较两组患者围术期相关指标、术后营养状况、生活质量、并发症及预后。结果两组手术时间、术中出血量、切口长度、术后首次排气及恢复进食时间、住院时间比较均无统计学差异(P>0.05),而π形吻合组吻合时间短于overlap吻合组(P<0.05)。两组患者术后3个月Alb、Hb、PAB、TP、RBC、球蛋白及铁蛋白等营养指标及QLQ-C30评分均明显改善(P<0.05),但两组间各营养指标及QLQ-C30评分比较均无统计学差异(P>0.05)。π形吻合组及overlap吻合组术后早、晚期并发症发生率分别为15.69%和21.57%、9.80%和7.84%,组间比较均无统计学差异(P>0.05)。术后均随访6~36个月,π形吻合组和overlap吻合组死亡率分别为27.45%和31.37%,两组患者平均生存时间无统计学差异(χ^(2)=0.367,P=0.545)。结论全腹腔镜全胃切除术中采用食管空肠π形吻合与overlap吻合技术行Roux-en-Y吻合均可有效改善患者的营养状况及生存质量,安全性较高,可作为消化道重建的选择方式之一。

Objective To explore the effect of π-shaped esophagojejunostomy and overlap esophagojejunostomy in the digestive tract reconstruction of totally laparoscopic total gastrectomy.Methods A total of 102 gastric cancer cases underwent totally laparoscopic total gastrectomy in our hospital from June 2018 to June 2021 were analyzed retrospectively,and were divided into π-shaped anastomosis group and overlap anastomosis group according to anastomosis procedure of digestive tract reconstruction,with 51 cases for each group.The peri-operative indexes,post-operative nutritional status,quality of life,complications and prognosis was compared between the two groups.Results There were no significant differences in the operation time,intraoperative blood loss volume,incision length,first exhaust time and first meal time after the operation and hospital stays between the two groups(P>0.05),but the anastomosis time was shorter in the π-shaped anastomosis group than that in the overlap anastomosis group(P<0.05).The nutritional indexes of Alb,Hb,PAB,TP,RBC,globulin and ferritin and QLQ-C30 scores were improved significantly in both groups three months after the operation(P<0.05).However,no statistical difference was found in nutritional indexes mentioned above and QLQ-C30 scores between the two groups(P>0.05).The post-operative complication rates of early and late stage was 15.69%vs.21.57% and 9.80%vs.7.84% in the π-shaped anastomosis group and the overlap anastomosis group respectively,without statistical differences between the two groups(P>0.05).All cases were followed up for 6 to 36 months.The mortality rate was 27.45% and 31.37% in the π shaped anastomosis group and the overlap anastomosis group,respectively.There was no significant difference in the average survival period between the two groups(χ^(2)=0.367,P=0.545).Conclusion Both π-shaped esophagojejunostomy and overlap esophagojejunostomy can improve the nutritional status and quality of life of gastric cancer patients with high safety in Roux-en-Y anastomosis of total laparoscopic total gastrectomy,and can be a recommended selection of gastrointestinal reconstruction procedure.