食管-管状胃吻合与双通道吻合在腹腔镜近端胃切除消化道重建中的对比研究

Comparative study on the application of esophageal tubular stomach anastomosis and double-channel anastomosis in gastrointestinal reconstruction after laparoscopic proximal gastrectomy

目的:探讨双通道吻合与食管管状胃吻合在近端胃切除消化道重建中的应用价值。方法:选取2021年6月至2023年6月收治的50例腹腔镜近端胃切除患者,按重建方式分为双通道吻合组(双通道组)与管状胃吻合组(管状胃组)。比较两组术中情况(手术时间、吻合器使用数量、术中出血量、淋巴结清扫数量)、术后应激指标、术后恢复情况(排气时间、住院时间)、术后并发症、术后6个月胃食管反流情况与营养状况、贫血状况。结果:管状胃组手术时间短于双通道组(P<0.05),吻合器使用数量少于双通道组(P<0.05),两组术中出血量、淋巴结清扫数量、术后中性粒细胞、术后C反应蛋白、术后排气时间、进食时间、术后住院时间、术后并发症发生率差异无统计学意义(P>0.05);术后6个月,双通道组反流性食管炎严重程度轻于管状胃组(P<0.05),BMI、白蛋白水平更高(P<0.05)。结论:食管管状胃吻合、双通道吻合在近端胃切除消化道重建中均具有较好的安全性、实用性,管状胃重建手术时间短,使用吻合器少;而双通道吻合短期内具有更好的抗反流效果与营养状况。

Objective:To investigate the application value of double-channel anastomosis and esophageal tubular stomach anastomosis in the reconstruction of the digestive tract after proximal gastrectomy.Methods:Fifty patients who underwent laparoscopic proximal gastrectomy from Jun.2021 to Jun.2023 were selected and divided into double-channel anastomosis group and tubular stomach anastomosis group according to the reconstruction method.The intraoperative conditions(operation time,number of anastomosis devices used,intraoperative blood loss,number of lymph nodes dissection),postoperative stress indicators,postoperative recovery(postoperative exhaust time,hospital stay),postoperative complications,postoperative 6-month gastroesophageal reflux,nutritional status and anemia status were compared between the two groups.Results:The operation time of the tubular stomach anastomosis group was shorter than that of the double-channel anastomosis group(P<0.05),and the number of anastomosis devices used was less(P<0.05).There were no significant differences in intraoperative blood loss,number of lymph nodes dissection,postoperative neutrophil count,postoperative C-reactive protein,postoperative ventilation time,feeding time,postoperative hospital stay,and postoperative complication rate between the two groups(P>0.05).At 6 months after operation,the severity of reflux esophagitis was lighter in the double-channel anastomosis group than that in the tubular stomach anastomosis group(P<0.05),and the BMI and albumin values were higher(P<0.05).Conclusions:Both esophageal tubular stomach anastomosis and double-channel anastomosis techniques demonstrate favorable safety and practicality in the reconstruction of digestive tract after proximal gastrectomy.The operation time of tubular stomach reconstruction is shorter,and fewer anastomosis devices are used.In contrast,double-channel anastomosis has better anti-reflux effect and nutritional status in the short term.