Functional Roux-en-Y Gastric Bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional Cases of Sleeve Gastrectomy

Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.

腹腔镜Roux-en-Y胃旁路术治疗肥胖糖尿病20例疗效分析

目的探讨腹腔镜Roux-en-Y胃旁路手术(LRYGB)治疗肥胖糖尿病的临床疗效。方法回顾性分析2012年~2018年新疆维吾尔自治区人民医院微创、疝腹壁外科中心实施LRYGB的20例肥胖糖尿病人的临床资料。结果20例手术均顺利完成,中转开腹病例1例。手术时间60~420分钟,平均(150±105.64)分钟,术中失血量20~100ml,平均(37.5±20.99)ml,术后住院时间5~15天,平均(8.25±2.51)天。术后5年内7例(35.00%)发生并发症,均为Clavien-Dindo分级Ⅱ级。术后1、3、5年的体重、体质指数(BMI)、糖化血红蛋白、空腹血糖、总体重减少百分比(TWL%)与术前比较均有改善,差异有统计学意义(P<0.05)。术后5年LRYGB治疗2型糖尿病完全缓解15例(75.00%)。结论LRYGB对肥胖2型糖尿病病人是一种有效的减重及降糖的术式。

Application value of enhanced recovery after surgery for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy

AIM To evaluate the safety and feasibility of enhanced recovery after surgery(ERAS) for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy.METHODS The clinical data of 42 patients who were divided into an ERAS group(n = 20) and a control group(n = 22) were collected. The observed indicators included operation conditions, postoperative clinical indexes, and postoperative serum stress indexes. Measurement data following a normal distribution are presented as mean ± SD and were analyzed by t-test. Count data were analyzed by χ~2 test.RESULTS The operative time, volume of intraoperative blood loss, and number of patients with conversion to opensurgery were not significantly different between the two groups. Postoperative clinical indexes, including the time to initial anal exhaust, time to initial liquid diet intake, time to out-of-bed activity, and duration of hospital stay of patients without complications, were significantly different between the two groups(t = 2.045, 8.685, 2.580, and 4.650, respectively, P < 0.05 for all). However, the time to initial defecation, time to abdominal drainage-tube removal, and the early postoperative complications were not significantly different between the two groups. Regarding postoperative complications, on the first and third days after the operation, the white blood cell count(WBC) and C reactive protein(CRP) and interleukin-6(IL-6) levels in the ERAS group were significantly lower than those in the control group.CONCLUSION The perioperative ERAS program for total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy is safe and effective and should be popularized. Additionally, this program can also reduce the duration of hospital stay and improve the degree of comfort and satisfaction of patients.

腹腔镜远端胃癌根治术中非离断Roux-en-Y吻合治疗胃癌的临床疗效及其对血清肿瘤因子水平的临床疗效

目的探讨腹腔镜远端胃癌根治术中非离断Roux-en-Y吻合治疗胃癌的临床疗效及其对血清肿瘤因子水平的影响。方法选取2020年1月至2023年3月该院收治的120例胃癌患者作为研究对象,采用随机数字表法分为治疗A组和治疗B组,每组60例。治疗A组进行腹腔镜远端胃癌根治术Bill-rothⅡ+Braun吻合治疗,治疗B组进行腹腔镜远端胃癌根治术非离断Roux-en-Y吻合治疗。观察并比较两组干预后的术中及术后情况、并发症发生情况、术后1年胃镜检查情况、术后生活质量、血清肿瘤标志物[癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)及糖类抗原125(CA125)]及炎症因子水平[白细胞介素6(IL-6)、C-反应蛋白(CRP)水平及白细胞计数(WBC)]。结果两组手术时长、术中出血量、术后排气时长、胃管留置时长、进流食时长、引流管留置时长、术后住院时长比较,差异均无统计学意义(P>0.05)。两组术后总健康状况、功能领域、症状领域生活质量评分比较,差异均无统计学意义(P>0.05)。干预后治疗A组出现食物潴留18例,残胃炎17例,胆汁反流1例,总发生率为60.00%(36/60);治疗B组出现食物潴留5例,残胃炎4例,胆汁反流0例,总发生率为15.00%(9/60)。两组术后1年胃镜检查情况比较,差异有统计学意义(χ^(2)=25.92,P<0.05)。两组术后CEA、CYFRA21-1及CA125水平均低于术前,且治疗B组CEA、CYFRA21-1及CA125水平均低于治疗A组,差异均有统计学意义(P<0.05)。两组术后IL-6、CRP水平及WBC均高于术前,且治疗B组IL-6、CRP水平及WBC均低于治疗A组,差异均有统计学意义(P<0.05)。两组纳入患者在治疗后均无严重不良并发症。治疗A组出现腹腔感染1例,腹腔出血2例,吻合口狭窄1例,十二指肠残端漏3例,其不良并发症的总发生率为11.67%(7/60);治疗B组出现腹腔感染3例,腹腔出血0例,吻合口狭窄1例,十二指肠残端漏1例,其不良并发症的总发生率为8.33%(5/60)。两组并发症总发生率比较,差异无统计学意义(χ^(2)=0.100,P>0.05)。结论腹腔镜远端胃癌根治术非离断Roux-en-Y吻合治疗胃癌患者的临床疗效更为显著,可有效改善患者的血清肿瘤标志物水平,可减轻炎症因子水平,降低不良并发症发生率,值得推广。

腹腔镜袖状胃切除术与Roux-en-Y胃旁路术治疗代谢综合征伴非酒精性脂肪肝患者的临床效果比较

目的比较腹腔镜袖状胃切除术(LSG)、Roux-en-Y胃旁路术(LRYGB)治疗代谢综合征(MS)伴非酒精性脂肪肝(NAFLD)的效果。方法前瞻性分析2021年4月至2022年10月焦作煤业(集团)有限责任公司中央医院收治的200例MS伴NAFLD患者,随机分为LRYGB组(腹腔镜LRYGB术)和LSG组(腹腔镜LSG术),各100例。比较两组手术指标、术后并发症、术前及术后6、12个月糖代谢指标[空腹血糖水平(FBG)、糖化血红蛋白水平(HbA1c)、胰岛素抵抗指数(HOMA-IR)]、脂代谢指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)]、减重情况[体重、体重指数(BMI)]、NAFLD病情控制情况。结果LSG组术中总失血量少于LRYGB组,手术用时、术后进食流食时间、术后初次排气时间、住院天数均短于LRYGB组(P<0.05),术后并发症发生率低于LRYGB组(P<0.05);术后6个月和12个月,两组LSG组HbA1c、FBG、HOMA-IR、TC、TG、LDL-C水平、体重、BMI均较术前降低,HDL-C水平均较术前升高(P<0.05),但两组间比较,差异无统计学意义(P>0.05)。术后6个月和12个月,NAFLD病情均较术前减轻,但两组NAFLD病情控制情况比较,差异无统计学意义(P>0.05)。结论LSG与LRYGB均可有效治疗MS伴NAFLD患者,可改善糖代谢指标、脂代谢指标、减重情况,有效控制NAFLD病情,但与LRYGB相比,LSG能减少术中总失血量,缩短手术用时,减少术后并发症的发生,促进术后快速恢复,在MS伴NAFLD患者治疗中更具有优势。

全机器人下根治性全胃切除+食管空肠Roux-en-Y吻合术(Overlap法)

2000年获得临床应用许可的达芬奇外科手术系统(da Vinci surgical system)作为一种创新的微创手术平台,提供了高清晰度的裸眼3D成像功能、有效的震颤过滤技术以及高精度灵活的模拟机械臂.根据目前研究证明,达芬奇机器人手术系统在胃癌手术治疗方面具有其安全性和可行性.灵活的机械臂,在胃周淋巴结清扫中更具优势,对周围器官的损伤更小,术后胰瘘发生率更低;缝合优势能更便利完成全机器人完全缝合重建,缩短腹腔暴露时间、减少腹腔体液丢失、降低手术对患者内环境稳态的干扰.

毕Ⅰ式吻合术与ROUX-en-Y吻合术在全腹腔镜远端胃癌根治术消化道重建中的效果

目的:比较毕Ⅰ式吻合术与ROUX-en-Y吻合术在全腹腔镜远端胃癌根治术消化道重建中的应用效果。方法:选取2022年1月—2023年12月于甘肃省武威肿瘤医院行全腹腔镜远端胃癌根治术的胃癌患者120例作为研究对象,随机分为对照组和研究组,各60例。对照组采用毕Ⅰ式吻合术进行消化道重建,研究组采用ROUX-en-Y吻合术进行消化道重建。比较两组围术期指标、并发症发生情况、术后疼痛情况及炎性因子水平。结果:研究组术中出血量少于对照组,首次排气时间早于对照组,住院时间短于对照组,差异有统计学意义(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05);研究组并发症总发生率低于对照组,差异有统计学意义(P=0.030);术后12h、24h、48h,研究组视觉模拟评分法评分低于对照组,差异有统计学意义(P<0.001);术后,两组白细胞介素-6、C反应蛋白水平升高,研究组低于对照组,差异有统计学意义(P<0.05)。结论:全腹腔镜远端胃癌根治术消化道重建中采用ROUX-en-Y吻合术较毕Ⅰ式吻合术效果更佳,能降低术中出血量,缩短术后恢复时间,降低并发症发生率,减轻疼痛,缓解炎性反应。

Sleeve Gastrectomy Associated with Antral Lesion Resection and Roux-en-Y Antrojejunal Reconstruction

Obesity has been growing worldwide, reaching epidemic proportions. Bariatric surgery is the most effective and durable treatment for severe obesity and related diseases. Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are the most frequently performed bariatric operations, with long-term good results, in terms of weight loss and comorbidities control. Gastroesophageal Reflux Disease (GERD) is commonly associated with obesity. In general, it precludes the indication of sleeve gastrectomy, since this technique has a refluxogenic potential, as shown in many studies. In such cases, RYGB is considered the best surgery, reaching good weight loss and gastroesophageal reflux disease control. The drawback of this technique is that it leaves the remnant stomach, the duodenum, and the proximal part of the jejunum inaccessible. Besides, RYGB makes transoral endoscopic access to the biliary tree impossible. For all these reasons, this bariatric technique is not indicated in cases of gastric polyposis, gastric dysplasia, or strong family history of cancer, among others. We report a case of a morbidly obese patient with intense GERD, for whom a RYGB was precluded due to her strong family history of cancer, even knowing that it would be the best choice for reflux disease control. Instead, SG was chosen, even knowing it could worsen the gastroesophageal reflux disease. The patient signed an informed consent, after being fully enlightened about the risks. During the surgery, a small subserosal whitish lesion was detected, near the pylorus, on the anterior wall of the antrum. Thinking in a Gastrointestinal Stromal Tumor (GIST), it was resected, with a 2 cm safety margin, leaving a 4 to 5 cm hole on the gastric wall. The decision to maintain the proposed sleeve gastrectomy was made, to avoid leaving a remnant stomach, in a patient with such a strong family history of cancer. In the area of the resected lesion, an intraoperative decision was made not to just close the big gastric hole, being afraid of causing some anatomic or functional disturbance in gastric emptying. Instead, we decided to use the gastric opening to construct a Roux-en-Y antrotrojejunal anastomosis, with a 50 cm alimentary limb and a 200 cm biliopancreatic limb. Accordingly, it was performed a sleeve gastrectomy, associated with an antrojejunostomy in a Roux-en-Y fashion. The patient had an uneventful postoperative course. In the second year, she achieved normal weight and good nutritional status, without gastroesophageal reflux symptoms complaints. Seriography study shows that most of the contrast material passes through the antrojejunal anastomosis, instead of the pylorus, while the duodenum is endoscopically patent. This case report shows an unexpected surgical finding that led to a tactic of adding a Roux-en-Y gastric bypass in the antrum, associated with a sleeve gastrectomy, a strategy that may be adopted in cases of morbidly obese patients with important GERD, for whom gastrointestinal exclusions are contraindicated. To confirm this hypothesis, controlled studies are needed.

Bariatric surgery in old age:a comparative study of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an Asia centre of excellence

Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly population.The aim of our study was to compare the safety and efficacy of laparoscopic Roux-en-Y gastric bypass（LRYGB） and sleeve gastrectomy（LSG） in patients aged more than 55 years.We performed2 a retrospective review of a prospectively collected database.All patients with body mass index（BMI） §32 kg/mand aged more than 55 years undergoing LRYGB or LSG in BMI Surgery Centre,E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the analysis.Demography,peri-operative data,weight loss and surgical complications were all recorded and analyzed.Mean age and BMI of these 68 patients22（22 males and 46 female） were 58.8 years（55-79 years） and 39.5 kg/m（32.00-60.40 kg/m）.LRYGB was performed in 44 patients and LSG in 24 patients.The two groups were comparable in their preoperative BMI,American Society of Anaesthesia（ASA） score and gender distribution.LSG patients were significantly older than patients receiving LRYGB.The proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients（88.63% vs.50%; P,0.01）.The prevalence of other co-morbidities was similar and comparable2 between the groups.Mean BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 kg/mand228.2 kg/m,respectively,and there was no statistically significant difference in mean percentage of excess weight loss（%EWL） at 1 year.The percentage of resolution of diabetes was significantly higher in LRYGB（69.2%） as compared to LSG（33.3%）.On the other hand,there was no statistical difference in the percentage of resolution of hypertension,hyperlipidemia and fatty liver hepatitis.The overall morbidity and re-operation rate was higher in LRYGB patients.In morbidly elderly patients,both surgeries achieved good weight loss and resolution of comorbidities.LRYGB is superior to LSG in terms of diabetes remission but carries higher complication rates even at high volume centres.

Surgical outcome of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass for resolution of type 2 diabetes mellitus:A systematic review and meta-analysis

BACKGROUND Bariatric procedures are considered superior to medical therapies in managing type 2 diabetes mellitus(T2DM).Laparoscopic Roux-en-Y gastric bypass(LRYGB)and laparoscopic sleeve gastrectomy(LSG)are the most commonly used procedures for weight loss and comorbidity resolution worldwide.However,it is not yet known whether the degree of T2DM is influenced by the choice of bariatric procedure.AIM To quantitatively compare T2DM resolution over 1-5 years follow-up by LRYGB and LSG in morbidly obese patients.METHODS We searched the selected databases for full-text English language clinical studies that compared the effectiveness of LRYGB and LSG for T2DM resolution.Review manager 5.3 was used for data analysis,and the overall effect summary was represented in a forest plot.RESULTS From 1,650 titles retrieved by an initial search,we selected nine studies for this research.We found insignificant differences for T2DM resolution by LRYGB and LSG,with an odds ratio of 0.93(95%CI:0.64-1.35,Z statistics=0.38,P=0.71).Additionally,subset analyses for T2DM resolution showed insignificant differences after 24 mo(χ^2=1.24,df=4,P=0.87,overall Z effect=0.23),36 mo(χ^2=0.41,df=2,P=0.81,overall Z effect=0.51),and 60 mo(χ^2=4.75,df=3,P=0.19,overall Z effect=1.20)by LRYGB and LSG.This study reports a T2DM remission rate of 82.3%by LRYGB and 80.7%by LSG.CONCLUSION This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of follow-up.However,long-term follow-up of 10 years is needed to further substantiate these findings.

腹腔镜Roux-en-Y胃旁路术与腹腔镜袖状胃切除术对改善肥胖患者血脂的Meta分析

目的:比较腹腔镜Roux-en-Y胃旁路术(LRYGB)与腹腔镜袖状胃切除术(LSG)对肥胖症的减重效果及对血脂的影响。方法:检索相关数据库,以获取比较LRYGB与LSG治疗肥胖患者及改善血脂的相关中、英文文献,检索时间自建库至2022年9月,对纳入文献进行质量评价、提取数据及数据统计分析。结果:共纳入15篇文献,其中LRYGB组4033例,LSG组4859例。与LSG组相比,LRYGB组术后甘油三酯水平较低[MD=-0.19,95%CI(-0.33,-0.04),P<0.05],总胆固醇水平较低[MD=-0.61,95%CI(-0.95,-0.28),P<0.05],低密度脂蛋白水平较低[MD=-0.54,95%CI(-0.85,-0.24),P<0.05];两组术后体质指数[MD=-0.10,95%CI(-0.23,0.02),P>0.05]、高密度脂蛋白[MD=-0.12,95%CI(-0.40,0.15),P>0.05]、血脂异常缓解率[RR=1.14,95%CI(0.99,1.30),P>0.05]差异无统计学意义。结论:LRYGB与LSG治疗肥胖症均是有效术式。与LSG相比,LRYGB能显著改善血脂,且甘油三酯、总胆固醇、低密度脂蛋白的降低效果更好,但两种术式在肥胖患者血脂异常缓解率方面效果相近。

Uncut Roux-en-Y吻合与毕Ⅱ+Braun吻合在腹腔镜远端胃癌根治术中的效果对比

目的:探讨Uncut Roux-en-Y吻合与毕Ⅱ+Braun吻合在腹腔镜远端胃癌根治术中的效果。方法:回顾性分析2020年3月—2022年3月于南京市江宁医院行腹腔镜远端胃癌根治术治疗的120例患者的病历资料,其中接受毕Ⅱ+Braun吻合的58例为A组,接受Uncut Roux-en-Y吻合的62例为B组。对比两组的手术指标、恢复情况、近期与远期并发症。结果:B组的手术时间、消化道重建时间短于A组,术中出血量少于A组(P<0.05)。两组的住院、术后排气、拔胃管、进流食及拔引流管时间比较差异无统计学意义(P>0.05)。两组的近期并发症发生率比较差异无统计学意义(P>0.05)。B组的远期并发症总发生率低于A组(3.23%<15.52%)(P<0.05)。结论:腹腔镜远端胃癌根治术中两种吻合方式的术后恢复情况、近期并发症情况相当,其中Uncut Roux-en-Y吻合方式更为安全可靠,手术时间、消化道重建时间相对更短,术中出血量和远期并发症相对更少。

Billroth Ⅱ与Roux-en-Y吻合对胃癌全腹腔镜远端胃切除术临床结局的影响

目的:探讨全腹腔镜远端胃切除术中Billroth Ⅱ与Roux-en-Y吻合对胃癌患者围手术期结局、营养状况及长期预后的影响,进一步明确两种吻合方式的可行性与安全性。方法:观察并分析2016年1月至2020年9月接受全腹腔镜远端胃切除术的125例胃癌患者的临床资料,根据消化道重建方式将患者分为Billroth Ⅱ组(n=68)与Roux-en-Y组(n=57),比较两组围手术期结局、术后并发症及营养指标。使用Kaplan-Meier曲线进行生存分析,比较两组预后结局。结果:两组术前临床资料差异无统计学意义(P>0.05)。Roux-en-Y组手术时间长于BillrothⅡ组,差异有统计学意义[(201.5±38.3)min vs.(184.1±34.2)min,P=0.028]。两组术中失血量、淋巴结获取数量、住院时间、首次排气时间、术后并发症、术后体重、营养指标及贫血指标差异均无统计学意义(P>0.05)。BillrothⅡ组与Roux-en-Y组5年无病生存率分别为69.8%与58.7%,差异无统计学意义(P=0.226)。结论:全腹腔镜远端胃切除术的消化道重建方式对胃癌患者围手术期结局、长期营养状况及生存结果无明显影响,BillrothⅡ吻合与Roux-en-Y吻合在全腹腔镜远端胃切除术中同样安全、有效。

Pyloric Sympathectomy: A Novel Way to Get Pylorus Relaxation? Report of Two Bariatric Cases

Objective: This case report aimed to demonstrate a possible neuromuscular effect of pyloric sympathectomy on the pylorus motility, leading to its permanent relaxation, observed in two bariatric surgical cases, one primary and the other, revisional. Background: Pyloric sphincter is a physiological barrier to free gastric emptying. In sleeve gastrectomy and in Roux-en-Y gastric bypass revisions, that put the remnant stomach in transit, the pylorus can contribute to generate a high intragastric pressure, which could lead to acute gastric fistulas and/or chronic gastroesophageal reflux disease. The possibility of functionally relaxing the pylorus, promoting intragastric pressure reduction, could represent a protective maneuver against these complications. Methods: We describe herein a surgical maneuver applied in two cases of bariatric surgeries, with the intention of facilitating antrum-duodenal region exposure, in a sleeve gastrectomy and in a Roux-en-Y gastric bypass conversion to SADI-S. For this, a ligation of terminal peripyloric vessels was done, allowing a passage of a tape, which surrounded the pylorus, for its traction. In both cases, 30-day and 1-year endoscopic evaluations were done, to assess esophagitis signs, anastomosis healing and anatomical pouch aspect. A clinical evaluation was also done, to assess gastroesophageal symptoms (validated questionnaire). Results: In the postoperative endoscopic evaluations, no esophagitis were observed in any case and the gastric pouches had normal aspect, with the expected anatomical findings, compatible with the surgeries performed. The anastomosis healed without problems, in the revisional case. Interestingly, in both cases, it was observed a complete pyloric sphincter relaxation, which lasted until 1-year endoscopic evaluation. There were no fistulas, nor esophagitis in any of these cases. Clinically, there were no symptoms of gastroesophageal reflux disease (validated questionnaire). Conclusion: The observation of a pyloric durable atomy, that followed peripyloric dissection and vessels ligation (arterial branches), with its concomitant sympathectomy, can represent a new way of decompressing gastric chamber, either in primary or revisional bariatric surgeries. This maneuver can be protective against acute fistulas and gastroesophageal disease. Additional studies are necessary to confirm this hypothesis.

腹腔镜辅助近端胃切除双通道吻合术与全胃切除Roux-en-Y消化道重建术治疗早期近端胃癌患者的效果比较

目的:比较腹腔镜辅助近端胃切除双通道吻合术与全胃切除Roux-en-Y消化道重建术治疗早期近端胃癌患者的效果。方法:回顾性分析2018年1月至2021年12月该院收治的128例早期近端胃癌患者的临床资料,根据手术方式不同将其分为对照组和研究组各64例。对照组采用全胃切除Roux-en-Y消化道重建术治疗,研究组采用腹腔镜辅助近端胃切除双通道吻合术治疗,比较两组手术相关指标(手术时间、术中出血量、淋巴结清扫数量、术后肛门首次排气时间、肠鸣音恢复时间、首次进流食时间、首次下床活动时间、住院时间)、手术前后胃肠功能指标[胃动素(MTL)、血管活性肠肽(VIP)、生长抑素(SS)]、营养指标(白蛋白、血红蛋白)水平,以及手术前后体质量减少率和并发症发生率。结果:两组手术时间、术中出血量比较,差异均无统计学意义(P>0.05);研究组淋巴结清扫数量少于对照组,术后肛门首次排气时间、肠鸣音恢复时间、首次进流食时间、首次下床活动时间、住院时间均短于对照组,差异有统计学意义(P<0.05);术后,对照组血清MTL水平低于术前,VIP水平高于术前,两组血清SS水平均低于术前,但研究组血清MTL、SS水平均高于对照组,VIP水平低于对照组,差异有统计学意义(P<0.05);术后2、3个月及1年,研究组血清白蛋白、血红蛋白水平均高于对照组,差异有统计学意义(P<0.05);术后1、2、3个月,研究组体质量减少率均低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为9.38%(6/64),低于对照组的28.12%(18/64),差异有统计学意义(P<0.05)。结论:与全胃切除Roux-en-Y消化道重建术相比,腹腔镜辅助近端胃切除双通道吻合术治疗早期近端胃癌患者可加快胃肠功能恢复,缩短卧床和住院时间,改善营养状态,降低并发症发生率,但淋巴结清扫数量较少。

腹腔镜非离断Roux-en-Y吻合远端胃癌根治术治疗T_(1~4)aN_(0~3)M_(0)胃癌的临床研究

目的观察腹腔镜非离断(Roux-en-Y)吻合远端胃癌根治术治疗T_(1~4)aN_(0~3)M_(0)胃癌的临床疗效,并探讨其对患者生活质量的影响。方法回顾性分析2019年5月至2022年7月宝鸡高新医院普通外科收治的80例T_(1~4)aN_(0~3)M_(0)胃癌患者的临床资料,根据手术方式不同分组,其中43例接受腹腔镜非离断Roux-en-Y吻合远端胃癌根治术治疗者纳入非离断组,37例接受腹腔镜传统Roux-en-Y吻合远端胃癌根治术治疗者纳入传统组。比较两组患者的手术指标、手术前后胃液pH值、生活质量及并发症发生情况。结果非离断组患者的半流质进食时间及手术时间分别为(4.83±1.64)d、(205.36±30.56)min,明显短于传统组的(8.10±1.86)d、(237.81±32.32)min,而出血量为(62.57±31.96)mL,明显少于传统组的(125.47±48.93)mL,差异均有统计学意义(P<0.05);非离断组患者术后5 d胃液pH值为6.12±0.41,明显高于传统组的5.92±0.40,差异有统计学意义(P<0.05);两组患者术后各项生活质量评分均较术前升高,且非离断组患者术后的各项评分升高幅度明显大于传统组,差异均有统计学意义(P<0.05);非离断组患者术后并发症总发生率为16.28%。略低于传统组患者的23.68%,但差异无统计学意义(P>0.05)。结论与腹腔镜传统Roux-en-Y吻合远端胃癌根治术比较,采用腹腔镜非离断Roux-en-Y吻合远端胃癌根治术治疗T_(1~4)aN_(0~3)M_(0)胃癌,手术时间明显缩短,术中出血量更少,患者生活质量显著提高。

腹腔镜辅助下近端胃切除术与腹腔镜辅助下全胃切除术加食道空肠Roux-en-Y吻合术治疗近端胃癌的效果比较

目的探讨腹腔镜辅助下近端胃切除术(LAPG)和腹腔镜辅助下全胃切除术加食道空肠Roux-en-Y吻合术(LATG-RY)治疗近端胃癌患者的临床疗效。方法回顾性分析2018年12月至2020年12月于上饶东信第五医院确诊的78例近端胃癌患者的临床资料,根据手术方式不同分为观察组(n=43)与对照组(n=35)。对照组采用LAPG治疗,观察组采用LATG-RY治疗,比较两组围手术期指标、肿瘤指标(淋巴结清扫数目、远近端切缘距离)、术后并发症发生情况、临床疗效及复发率。结果观察组手术出血量多于对照组,手术时间长于对照组,差异有统计学意义(P<0.05);两组手术切口长度、首次通气时间、首次进食时间、住院时间及治疗费用比较差异无统计学意义。观察组近端切缘、远端切缘均长于对照组,淋巴结清扫数目多于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率为13.95%,低于对照组40.00%,差异有统计学意义(P<0.05)。观察组治疗总有效率为95.35%,高于对照组77.14%,差异有统计学意义(P<0.05)。观察组复发率为2.33%,低于对照组的20.00%,差异有统计学意义(P<0.05)。结论LATG-RY和LAPG治疗近端胃癌均具有一定安全性、有效性,LATG-RY术后并发症少、临床疗效显著、复发率低;LAPG手术出血量少,手术时间、近端切缘、远端切缘均较短,淋巴结清扫数目少,临床可结合患者病情及其自身意见选择最适合的术式。

全3D腹腔镜胃切除结合食管空肠Roux-en-Y吻合术治疗胃癌的效果

目的探究全3D腹腔镜根治性全胃切除结合食管空肠Roux-en-Y吻合术用于早中期胃癌中的效果观察。方法回顾性研究法选择2020年6月至2022年6月收治早中期胃癌患者72例为研究对象,以不同手术方法法分为对照组(n=36)以及观察组(n=36),对照组接受腹腔镜辅助全胃切除术+食管空肠Roux-en-Y吻合术,观察组给予全3D腹腔镜根治性全胃切除+食管空肠Roux-en-Y吻合术,比较两组治疗后效果差异。结果观察组肠鸣音恢复以及肛门首次排气时间均短于对照组,淋巴结清除量较对照组高且术中出血量较对照组少(P<0.05);术后观察组CEA、AFP肿瘤标志物水平与对照组比较无明显差异(P>0.05);术后观察组DAO、ET、ZO-1、OCLN胃肠屏障功能指标水平均较对照组低(P<0.05)。结论全3D腹腔镜根治性全胃切除结合食管空肠Roux-en-Y吻合术用于早中期胃癌中疗效显著,可改善机体胃肠屏障功能。

腹腔镜远端胃癌根治术消化道重建中非离断式Roux-en-Y吻合的应用价值

目的探讨腹腔镜远端胃癌根治术消化道重建中非离断式Roux-en-Y吻合的应用价值。方法回顾性分析2018年8月至2021年8月荆州市第三人民医院收治的86例胃癌患者临床资料,依据术中消化道重建方式不同分为对照组与观察组,每组43例。对照组采用传统Roux-en-Y吻合,观察组采用非离断式Roux-en-Y吻合,比较两组围手术期指标、胃肠功能恢复时间、营养指标、生命质量及并发症发生情况。结果两组手术时间、消化道重建时间比较差异无统计学意义;观察组术中出血量少于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。观察组术后肠鸣音恢复时间、排气时间及排便时间均短于对照组,差异有统计学意义(P<0.05)。术后,两组前白蛋白(PA)、白蛋白(ALB)水平均低于术前,对照组转铁蛋白(TRF)水平低于术前,但观察组PA、ALB、TRF水平均高于对照组,差异有统计学意义(P<0.05),观察组手术前后TRF水平比较差异无统计学意义。术后,两组生理、心理、社会及环境领域评分均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论非离断式Roux-en-Y吻合在腹腔镜远端胃癌根治术消化道重建中的应用效果更佳,能加快胃肠功能恢复,促进机体营养状态复常,提高患者生命质量,安全性较高。

Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis

AIM To compare uncut Roux-en-Y(U-RY) gastrojejunostomy with Roux-en-Y(RY) gastrojejunostomy after distal gastrectomy(DG) for gastric cancer.METHODS A literature search was conducted in Pubmed, Embase, Web of Science, Cochrane Library, Science Direct, Chinese National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database to identify studies comparing U-RY with RY after DG for gastric cancer until the end of December 2017. Pooled odds ratio or weighted mean difference with 95% confidence interval was calculated using either fixed-or random-effects models. Perioperative outcomes such as operative time, intraoperative blood loss, and hospital stay; postoperative complications such as anastomotic bleeding, stricture and ulcer, reflux gastritis/esophagitis, delayed gastric emptying, and Roux stasis syndrome; and postoperative nutritional status(serum hemoglobin, total protein, and albumin levels) were the main outcomes assessed. Metaanalyses were performed using RevM an 5.3 software.RESULTS Two randomized controlled trials and four nonrandomized observational clinical studies involving 403 and 488 patients, respectively, were included. The results of the meta-analysis showed that operative time [weighted mean difference(WMD):-12.95; 95%CI:-22.29 to-3.61; P = 0.007] and incidence of reflux gastritis/esophagitis(OR: 0.40; 95%CI: 0.20-0.80; P = 0.009), delayed gastric emptying(OR: 0.29; 95%CI: 0.14-0.61; P = 0.001), and Roux stasis syndrome(OR: 0.14; 95%CI: 0.04-0.50; P = 0.002) were reduced; and the level of serum albumin(WMD: 0.71; 95%CI: 0.24-1.19; P = 0.003) was increased in patients undergoing U-RY reconstruction compared with those undergoing RY reconstruction. No differences were found with respect to intraoperative blood loss, hospital stay, anastomotic bleeding, anastomotic stricture, anastomotic ulcer, the levels of serum hemoglobin, and serum total protein. CONCLUSION U-RY reconstruction has some clinical advantages over RY reconstruction after DG.