全腹腔镜下食管-空肠π吻合在贲门癌根治术中的近期安全性研究

Short term safety research of total laparoscopic π-shaped esophagojejunal anastomosis in radical surgery for adenocarcinoma of esophagogastric junction

目的比较全腹腔镜下食管-空肠π式吻合与腹腔镜辅助食管-空肠Roux-en-Y吻合在贲门癌全胃切除术的近期临床疗效及安全性。方法分析2020年6月—2022年7月在蚌埠医科大学第一附属医院治疗的72例食管胃结合部腺癌患者的临床及病理资料。所有患者均行腹腔镜全胃切除+D2淋巴结清扫术,其中38例患者行全腹腔镜下贲门癌根治术+食管-空肠π吻合(全腹腔镜组),34例患者采用腹腔镜辅助贲门癌根治术+食管-空肠Roux-en-Y吻合(腹腔镜辅助组),分析不同术式的安全性及对应激反应的影响。结果全腹腔镜组手术时间长于腹腔镜辅助组且手术切口长度显著短于腹腔镜辅助组(P<0.001)。全腹腔镜组术中出血量[(130.26±23.54)mL]明显低于腹腔镜组[(167.21±28.53)mL,t=6.017,P<0.001]。全腹腔镜组术后首次排气时间明显短于腹腔镜辅助组(P=0.003)。2组术后拔除引流管时间、术后住院时间、术后并发症发生情况及手术清扫淋巴结个数比较,差异均无统计学意义(P>0.05)。术后第1天和第5天全腹腔镜组患者血清CRP水平显著低于腹腔镜辅助组(P<0.05)。结论全腹腔镜下贲门癌根治+食管-空肠π吻合的手术方式是安全的,能够减少术中出血,缩短患者恢复时间,缓解术后疼痛,减少术后并发症的发生,且对机体创伤性应激反应的影响较小。

Objective To analyze the short-term clinical efficacy and safety of total laparoscopicπ-shaped esophageal jejunostomy and laparoscopic assisted Roux-en-Y esophago-jejunostomy for adenocarcinoma of the esophagogastric junction.Methods The clinical and pathological data of 72 patients with adenocarcinoma of the esophagogastric junction treated in the First Affiliated Hospital of Bengbu Medical University from June 2020 to July 2022 were collected.All patients underwent laparoscopic total gastrectomy+D2 lymphadenectomy,in whom 38 patients underwent total laparoscopic radical resection of cardiac cancer+π-shaped esophageal jejunostomy and 34 patients underwent laparoscopic-assisted radical resection of cardiac cancer+Roux-en-Y esophago-jejunostomy.The safety and effects on stress response indicators of different surgical methods were analyzed.Results The mean operation time of the total endoscopy group was longer than that of the laparoscopic-assisted group and the length of the incision was significantly shorter than that in the laparoscopic-assisted group(P<0.001).In terms of intraoperative bleeding,the amount of intraoperative bleeding in the total endoscopy group(130.26±23.54)mL was significantly lower than that in the laparoscopic group[(167.21±28.53)mL,t=6.017,P<0.001].The first postoperative exhaust time in the total endoscopy group was significantly lower than that in the laparoscopic-assisted group(P=0.003).There were no significant differences in extubation time,postoperative hospitalization days,postoperative complications,and number of surgically removed lymph nodes between the two groups(P>0.05).The serum level of CRP in the total endoscopy group was significantly lower than that in the laparoscopic-assisted group on the first and fifth day after surgery(P<0.05).Conclusion Total laparoscopic radical resection of cardiac cancer+πesophagojejunostomy is safe,which can reduce intraoperative bleeding,shorten the recovery time of patients,relieve postoperative pain,greatly reduce the occurrence of postoperative complications,and has little effect on the body's traumatic stress response.