三角吻合技术联合腹腔镜在全胃切除术中应用对患者恢复效果和安全性的影响

Effect of delta-shaped anastomosis combined with laparoscopy on recovery and safety of patients undergoing total gastrectomy

目的探讨腹腔镜全胃切除术中应用三角吻合技术的临床效果和安全性。方法选取2016年3月至2017年5月收治的行腹腔镜全胃切除术手术治疗的胃癌患者90例作为研究对象,按照随机数字表法分成两组,对照组(45例)使用Roux-en-Y吻合技术,观察组(45例)采用三角吻合技术,采用EORTC-QLQ-C30生活质量量表对手术前后患者的生活质量进行评价,比较两组患者术后恢复效果,记录两组患者的并发症发生率。结果观察组术后第一次排气时间为(4.26±1.03)d、第一次进食时间为(6.05±1.04)d、下床活动时间为(0.83±0.30)d,对照组数据依次为(4.68±1.80)d、(6.44±2.82)d、(0.88±0.36)d,两组比较差异无统计学意义(t=1.359,t=0.870,t=0.716,P均>0.05);术前两组患者的EORTC-QLQ-C30各维度评分差异无统计学意义(P均>0.05),出院前两组患者生活质量各维度评分明显优于术前,且观察组优于对照组(P均<0.05);观察组术后并发症发生率为2.22%,低于对照组的28.89%(χ~2=12.180,P<0.01)。结论胃癌患者行腹腔镜全胃切除术治疗中采用三角吻合技术能够确保安全性,加快患者术后机体恢复,改善患者的生活质量。

Objective To explore the clinical efficacy and safety of delta-shaped anastomosis(DA)in laparoscopic total gastrectomy(TG).Methods A total of 90 patients with gastric cancer(GC)undergoing laparoscopic TG surgery from March 2016 to May 2017 were enrolled and randomly divided into observation group and control group(n=45,each).Roux-en-Y anastomosis technique was used in control group,and DA was performed in observation group.Quality of life scale(EORTC-QLQ-C30)was used to evaluate the life quality of patients before and after surgery.Postoperative recovery and incidence of complications were observed and compared between two groups.Results There were no statistical differences in the first exhaust time[(4.26±1.03)d vs(4.68±1.80)d,t=1.359],the first eating time[(6.05±1.04)d vs(6.44±2.82)d,t=0.870]and the time getting out of bed[(0.83±0.30)d vs(0.88±0.36)d,t=0.716]between two groups(all P>0.05).Before operation,EORTC-QLQ-C30 dimension scores were similar between two groups(all P>0.05)and were significantly improved before discharge compared with those before surgery in two groups.The improvement effect in observation group was superior to that in control group(P<0.05).The complication rate in observation group was significantly lower than that in control group(2.22%vs 28.89%,χ~2=12.180,P<0.01).Conclusion Laparoscopic total gastrectomy with delta-shaped anastomosis for GC patients can ensure safety,speed up the recovery of the body and improve the life quality of patients after surgery.