改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究

Safety and efficacy of modifiedπ-type anastomosis in laparoscopic total gastrectomy for digestive tract reconstruction

目的研究改良π形吻合在腹腔镜全胃切除(LTG)消化道重建中的安全性和有效性。方法回顾性分析2018年1月至2023年1月接受LTG治疗的80例胃癌患者的临床资料。根据吻合方式的不同分为改良组和π形组,改良组(n=36)采用改良π形吻合法,π形组(n=44)采用传统的π型吻合法。数据应用软件SPSS 22.0分析,术中指标、术后恢复指标等计量资料采用()表示,行独立样本t检验;术后并发症等计数资料行χ2检验;生存分析采用Kaplan-Meier法行Log-Rank检验。P<0.05为差异有统计学意义。结果改良组手术时间及吻合时间较π形组显著降低(P<0.05),上切缘距离显著延长(P<0.05);两组患者术中出血量、淋巴结清扫数目、切口长度、术后恢复情况及术后生存情况比较,差异均无统计学意义(P>0.05),且两组患者术后经胃镜或消化道造影检查提示吻合口均通畅;改良组术后并发症的总发生率显著低于π形组(11.1%vs.29.5%,P<0.05);术后中位随访时间37(5~64)个月,两组患者累积总生存率(83.3%vs.77.3%)及无病生存率(80.6%vs.75.0%)比较,差异均无统计学意义(P=0.830、0.846)。结论改良π形吻合在LTG消化道重建中是安全、有效的,不仅降低了手术难度,缩短了手术时间,还获得了更高的安全切缘,并有效降低了术后并发症的发生,提高了手术的安全性。

Objective To investigate the safety and efficacy of modifiedπ-type anastomosis in laparoscopic total gastrectomy(LTG)for digestive tract reconstruction.Methods The clinical data of 80 patients with gastric cancer who received LTG from January 2018 to January 2023 were retrospectively analyzed.Among them,36 patients received LTG(improved group)by improvedπ-shaped anastomosis,and 44 patients received LTG(π-shaped group)by traditionalπ-shaped anastomosis.The data were analyzed using SPSS 22.0 software,and the measurement data such as intraoperative conditions and postoperative recovery were expressed by(),and independent t test was performed.The statistical data of postoperative complications wereχ2 test.Kaplan-Meier method and Log-Rank test were used for survival analysis.P<0.05 was considered statistically significant.Results The operation time and anastomosis time of the improved group were significantly reduced compared with theπ-shaped group(P<0.05),and the distance of the upper incisal margin was significantly extended(P<0.05).There was no significant difference in intraoperative blood loss,number of lymph node dissection,incision length,postoperative recovery and postoperative survival between the two groups(P>0.05),and postoperative gastroscopy or gastrointestinal angiography showed that the anastomosis was patency in both groups.The overall incidence of postoperative complications in the improved group was significantly lower than that in theπ-shaped group(11.1%vs.29.5%,P<0.05).The median follow-up was 37(5~64)months.There was no significant difference in cumulative overall survival(83.3%vs.77.3%)and disease-free survival(80.6%vs.75.0%)between the two groups(P=0.830,0.846).Conclusion The modifiedπ-shape anastomosis is safe and effective in the digestive tract reconstruction of LTG,which not only reduces the difficulty of surgery,shorens the operation time,but also obtains a higher safe incision margin,effectively reduces the occurrence of postoperative complications,and improves the safety of surgery.