Optimal choice of stapler and digestive tract reconstruction method after distal gastrectomy for gastric cancer:A prospective case–control study

BACKGROUND Gastric cancer is the most common cause of cancer-related deaths,and is classified according to its location in the proximal,middle,or distal stomach.Surgical resection is the primary approach for treating gastric cancer.This prospective study aimed to determine the best reconstruction method after distal gastrectomy for gastric cancer.AIM To explore the efficacy of different staplers and digestive tract reconstruction(DTR)methods after radical gastrectomy and their influence on prognosis.METHODS Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer at our institution between April 2017 and April 2020 were included in this study,with a follow-up period of 12-26 mo.The patients were assigned to four groups based on the stapler and DTR plan as follows:BillrothⅠ(B-I)reconstruction+linear stapler group(group A,22 cases),B-I reconstruction+circular stapler group(group B,22 cases),Billroth II(B-II)reconstruction+linear stapler group(group C,22 cases),and B-II reconstruction+circular stapler group(group D,21 cases).The pathological parameters,postoperative gastrointestinal function recovery,postoperative complications,and quality of life(QOL)were compared among the four groups.RESULTS No significant differences in the maximum diameter of the gastric tumors,total number of lymph nodes dissected,drainage tube removal time,QLQ(QOL questionnaire)-C30 and QLQ-STO22 scores at 1 year postoperatively,and incidence of complications were observed among the four groups(P>0.05).However,groups A and C(linear stapler)had significantly lower intraoperative blood loss and significantly shorter anastomosis time,operation time,first fluid diet intake time,first exhaust time,and length of postoperative hospital stay(P<0.05)than groups B and D(circular stapler).CONCLUSION Linear staplers offer several advantages for postoperative recovery.B-I and B-II reconstruction methods had similar effects on QOL.The optimal solution can be selected according to individual conditions and postoperative convenience.

Three-dimensional computed tomography reconstruction diagnosed digestive tract perforation and acute peritonitis caused by Monopterus albus:A case report

BACKGROUND Few reports have described living foreign bodies in the human body.The current manuscript demonstrates that computed tomography(CT)is an effective tool for accurate preoperative evaluation of living foreign bodies in clinic.The threedimensional(3D)reconstruction technology could clearly display anatomical structures,lesions and adjacent organs,improving diagnostic accuracy and guiding the surgical decision-making process.CASE SUMMARY Herein we describe a 68-year-old man diagnosed with digestive tract perforation and acute peritonitis caused by a foreign body of Monopterus albus.The patient pre-sented to the emergency department with complaints of dull abdominal pain,profuse sweating and a pale complexion during work.A Monopterus albus had entered the patient’s body through the anus two hours ago.During hospitalization,the 3D reconstruction technology revealed a perforation of the middle rectum complicated with acute peritonitis and showed a clear and complete Monopterus albus bone morphology in the abdominal and pelvic cavities,with the Monopterus albus biting the mesentery.Laparoscopic examination detected a large(diameter of about 1.5 cm)perforation in the mid-rectum.It could be seen that a Monopterus albus had completely entered the abdominal cavity and had tightly bitten the mesentery of the small intestine.During the operation,the dead Monopterus albus was taken out.CONCLUSION The current manuscript demonstrates that CT is an effective tool for accurate preoperative evaluation of living foreign bodies in clinic.

Pancreaticojejunostomy, hepaticojejunostomy and double Roux-en-Y digestive tract reconstruction for benign pancreatic diseases

Surgery such as digestive tract reconstruction is usually required for pancreatic trauma and severe pancreatitis as well as malignant pancreatic lesions. The most common digestive tract reconstruction techniques(e.g., Child's type reconstruction) for neoplastic diseases of the pancreatic head often encompass pancreaticojejunostomy, choledochojejunostomy and then gastrojejunostomy with pancreaticoduodenectomy, whereas these techniques may not be applicable in benign pancreatic diseases due to an integrated stomach and duodenum in these patients. In benign pancreatic diseases, the aforementioned reconstruction will not only increase the distance between the pancreaticojejunostomy and choledochojejunostomy, but also the risks of traction, twisting and angularity of the jejunal loop. In addition, postoperative complications such as mixed fistula are refractory and life-threatening after common reconstruction procedures. We here introduce a novel pancreaticojejunostomy, hepaticojejunostomy and double Roux-en-Y digestive tract reconstruction in two cases of benign pancreatic disease, thus decreasing not only the distance between the pancreaticojejunostomy and choledochojejunostomy, but also the possibility of postoperative complications compared to common reconstruction methods. Postoperatively, the recovery of these patients was uneventful and complications such as bile leakage, pancreatic leakage and digestive tract obstruction were not observed during the follow-up period.

Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer

In addition to the popularity of laparoscopic gastrectomy(LG),many reconstructive procedures after LG have been reported.Surgical resection and lymphatic dissection determine long-term survival;however,the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer(GC).Presently,no consensus exists regarding the optimal reconstructive procedure.In this review,the current state of digestive tract reconstruction after LG is reviewed.According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction,we divide these reconstruction procedures into three categories consistent with the resection procedures.We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes(length of surgery and blood loss)and postoperative complications(anastomotic leakage and stricture)to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.

Effects on the pouch of different digestive tract reconstruction modes assessed by radionuclide scintigraphy

AIM: To determine the effect of three digestive tract reconstruction procedures on pouch function, after radical surgery undertaken because of gastric cancer, as assessed by radionuclide dynamic imaging. METHODS: As a measure of the reservoir function, with a designed diet containing technetium-99m (99mTc), the emptying time of the gastric substitute was evaluated using a 99mTc-labeled solid test meal. Immediately after the meal, the patient was placed in front of a γ camera in a supine position and the radioactivity was measured over the whole abdomen every minute. A frame image was obtained. The emptying sequences were recorded by the microprocessor and then stored on a computer disk. According to a computer processing system, the half-emptying actual curve and the fitting curve of food containing isotope in the detected region were depicted, and the half-emptying actual curves of the three reconstruction procedures were directly compared. RESULTS: Of the three reconstruction procedures, the half-emptying time of food containing isotope in the Dual Braun type esophagojejunal anastomosis procedure (51.86±6.43 min) was far closer to normal, signif icantly better than that of the proximal gastrectomy orthotopic reconstruction (30.07±15.77 min, P=0.002) and P type esophagojejunal anastomosis (27.88±6.07 min, P=0.001) methods. The half-emptying actual curve and f itting curves for the Dual Braun type esophagojejunal anastomosis were fairly similar while those of the proximal gastrectomy orthotopic reconstruction and P type esophagojejunal anastomosis were obviously separated, which indicated bad food conservation in the reconstructed pouches. CONCLUSION: Dual Braun type esophagojejunal anastomosis is the most useful of the three procedures for improving food accommodation in patients with a pouch and can retard evacuation of solid food from the reconstructed pouch.

Digestive tract reconstruction pattern as a determining factor in postgastrectomy quality of life

Postgastrectomy quality of life(QoL)is affected by various symptoms,and compared with the preoperative baseline QoL,is typically impaired for the first 6 mo after surgery.Thereafter,improvement to a stable QoL is observed at approximately 12 mo postoperatively.We consider the digestive tract reconstruction pattern to be a determining factor in postgastrectomy QoL among gastric cancer patients,and believe it requires further discussion.Proximal gastrectomy is associated with the worst postoperative QoL among gastrectomy procedures and should be performed cautiously.The trend of better QoL provided by the pouch procedure of total gastrectomy requires further robust support.Whether the use of Billroth-Ⅰgastroduodenostomy or Roux-en-Y gastrojejunostomy for distal gastrectomy is optimal remains controversial,but Roux-en-Y gastrojejunostomy is likely to be preferable.

Duct-to-duct biliary reconstruction after radical resection of Bismuth Ⅲ a hilar cholangiocarcinoma

At present, radical resection remains the only effective treatment for patients with hilar cholangiocarcinoma. The surgical approach for R0 resection of hilar cholangiocarcinoma is complex and diverse, but for the biliary reconstruction after resection, almost all surgeons use Roux-en-Y hepaticojejunostomy. A viable alternative to Roux-en-Y reconstruction after radical resection of hilar cholangiocarcinoma has not yet been proposed. We report a case of performing duct-to-duct biliary reconstruction after radical resection of Bismuth Ⅲa hilar cholangiocarcinoma. End-to-end anastomosis between the left hepatic duct and the distal common bile duct was used for the biliary reconstruction, and a singlelayer continuous suture was performed along the bile duct using 5-0 prolene. The patient was discharged favorably without biliary fistula 2 wk later. Evidence for tumor recurrence was not found after an 18 mo follow- up. Performing bile duct end-to-end anastomosis in hilar cholangiocarcinoma can simplify the complex digestive tract reconstruction process.

非离断式Roux-en-Y吻合术在胃癌消化道重建中的应用效果及对胃肠道屏障功能、胆囊收缩功能的影响

目的探讨非离断式Roux-en-Y吻合术在胃癌消化道重建中的应用效果及对胃肠道屏障功能、胆囊收缩功能的影响。方法选取2020年2月至2022年2月收治的40例行胃癌消化道重建手术患者,按照吻合方法不同将其分为对照组和观察组,各20例。对照组采用传统Roux-en-Y吻合术,观察组采用非离断式Roux-en-Y吻合术。比较两组的治疗效果。结果术后1 d,观察组的血浆D-乳酸、二胺氧化酶(DAO)水平均低于对照组(P<0.05)。术后,观察组的双歧杆菌、乳杆菌、拟杆菌数量多于对照组(P<0.05)。术后1 d,观察组的胆囊收缩素水平低于对照组,胆囊容积、胆囊排空率高于对照组(P<0.05)。观察组的并发症总发生率低于对照组(P<0.05)。结论非离断式Roux-en-Y吻合术应用于胃癌消化道重建中有助于改善患者的胃肠道屏障功能、胃肠道微生态平衡及胆囊收缩功能,减少并发症发生。

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。

Uncut Roux-en-Y吻合术在腹腔镜远端胃癌根治术消化道重建中的临床应用

目的:探讨非离断(Uncut)Roux-en-Y吻合术在腹腔镜远端胃癌根治术消化道重建中的临床应用。方法:回顾性分析2019年1月-2021年12月在南京医科大学附属无锡第二医院接受远端胃癌根治手术的79例患者的临床资料。根据消化道重建方式的不同分为对照组(n=30)和观察组(n=49)。对照组行Roux-en-Y吻合术,观察组行Uncut Roux-en-Y吻合术。比较两组围手术期情况和并发症,术后3个月Roux-en-Y滞留综合征(RSS)、残胃炎和胆汁反流发生率及营养状况。结果:与对照组比较,观察组消化道重建时间、首次排气时间均明显缩短,差异均有统计学意义(P<0.05)。两组围手术期并发症发生率比较,差异无统计学意义(P>0.05)。术后3个月,观察组RSS、残胃炎和胆汁反流发生率均明显低于对照组,差异均有统计学意义(P<0.05)。术后3个月,观察组总蛋白、白蛋白和血红蛋白水平均高于对照组,差异均有统计学意义(P<0.05)。结论:Uncut Roux-en-Y吻合术能够缩短消化道重建时间,降低术后RSS、残胃炎和胆汁反流发生率,改善营养状况。

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。

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。

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China:a national questionnaire survey

Background:Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method:A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results:A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)pancreatojejunostomy was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of gastrojejunostomy(GJ)cases,the distance between GJ and hepaticojejunostomy<30,30-50,and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion:Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China: a national questionnaire survey

Background Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)PJ was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of GJ cases,the distance between GJ and HJ<30 cm,30-50 cm and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.

全腹腔镜远端胃癌根治术胃空肠Roux-en-Y吻合的临床应用

目的介绍全腹腔镜远端胃癌根治术后采用胃空肠Roux-en-Y吻合进行消化道重建的手术方式。方法回顾性总结10例远端胃癌患者施行全腹腔镜下远端胃癌根治术后采用胃空肠Roux-en-Y吻合的消化道重建方式的具体手术方法和术后恢复情况。结果 10例患者均完成全腹腔镜下Roux-en-Y重建,出血量为(57.0±19.5)ml,消化道重建时间(48.0±15.3)分钟,术后患者胃管拔除时间为(4.4±0.7)天,术后住院时间为(8.0±1.2)天,平均清扫淋巴结(27.5±4.7)枚,下切缘距病变距离为(3.0±0.6)cm,上切缘距病变距离为(4.9±0.8)cm,未发生手术相关并发症。结论全腹腔镜下采用胃空肠Roux-en-Y吻合的重建方式操作简便,安全有效,术后并发症少,患者生活质量高,是一种理想的全腹腔镜胃癌手术方式。

uncut Roux-en-Y吻合在腹腔镜辅助下胃癌根治术中的临床应用

目的比较腹腔镜辅助下胃癌根治术后B-I式、B-II式、RY吻合、uncut Roux-en-Y(uncut RY)吻合的手术情况及术后并发症。方法回顾性分析南昌大学第一附属医院2014年1月至2016年5月行腹腔镜辅助下胃癌根治术的患者121例,根据不同的消化道重建方式分为:B-I式组35例,B-II式组29例,RY组25例,uncut RY组32例。全组患者术后随访6个月以上,比较其近期、远期并发症发生率。结果 uncutRY组在术后首次通气时间、术后恢复流质饮食时间较B-II式及RY组缩短,术后反流性胃炎、反流性食管炎发生率减少,Roux潴留综合征发生率较RY组下降。结论 uncut Roux-en-Y吻合术能明显改善患者生存质量,是腹腔镜辅助下胃癌根治术后理想的消化道重建方式。

全胃切除术后改良Orr式Roux-en-Y食管空肠吻合术的临床研究

目的探讨改良Orr式Roux-en-Y食管空肠吻合术的临床应用价值。方法胃癌行全胃切除术患者共38例,消化道重建按手术日期随机分为ρ型食管空肠吻合组(ρ型组)20例及改良Orr式Roux-en-Y食管空肠吻合组(改良组)18例。比较2组的手术时间、术中出血量、术后并发症发生率、贮袋排空时间和术前及术后3个月时的体重变化情况。结果改良组和ρ型组的手术时间分别为(229±18)min和(283±35)min(P<0.05);贮袋全排空时间分别为(35.7±4.9)min和(3.0±0.5)min(P<0.01)。在术中出血量、术后并发症发生率和体重变化方面,2组间差异无统计学意义(P>0.05)。结论改良Orr式Roux-en-Y食管空肠吻合术有利于操作,可节省手术时间,有一定贮袋功能,不增加并发症,有临床应用价值。

非离断式Roux-en-Y吻合在腹腔镜远端胃癌根治术中的应用

目的探讨非离断(uncut)Roux-en-Y吻合技术在腹腔镜辅助远端胃癌根治术消化道重建中的安全性和效果。方法回顾性分析2017年1月~2018年1月腹腔镜辅助远端胃癌根治术70例资料,2017年1~6月行Roux-en-Y吻合(26例,RY组),2017年7月~2018年1月行非离断Roux-en-Y吻合(44例,Uncut RY组)。术后随访6个月以上,比较其术后恢复情况、并发症发生率。结果Uncut RY组排气时间[(29.0±7.4)h]早于RY组[(38.0±5.7)h](t=-5.311,P=0.000),Roux瘀滞综合征(Roux stasis syndrome,RSS)发生率(0%,0/44)低于RY组(34.6%,9/26)(P=0.000)。术后6个月,Uncut RY组体重、血浆白蛋白水平达到术前的比例高于RY组[68.2%(30/44)vs.42.3%(11/26),χ^2=4.509,P=0.034;81.8%(36/44)vs.50.0%(13/26),χ^2=7.879,P=0.005]。结论非离断Roux-en-Y吻合术后并发症发生率低,能明显改善胃癌患者手术后生活质量及营养状况,是腹腔镜辅助远端胃癌根治术理想的消化道重建术式。

裤形吻合与RY吻合方式在胃癌全胃切除后的应用价值比较

目的:比较裤形吻合与Roux-en-Y(RY)吻合方式在胃癌全胃切除后的应用价值。方法:选取2020年1月至2023年5月我院收治的行全胃切除术治疗的胃癌患者108例作为研究对象,分为RY吻合组54例、裤形吻合组54例,两组均接受全胃切除术治疗,RY吻合组、裤形吻合组分别于胃癌全胃切除术后以RY吻合方式、裤形吻合方式行消化道重建。比较两组手术指标、术后并发症、营养指标[总蛋白(TP)、血红蛋白(Hb)、血清白蛋白(ALB)及预后营养指数(PNI)]、生命质量(QLQ-C30)及远期不良事件发生率。结果:两组患者手术指标比较无意义(P>0.05)。RY吻合组术中1例由于肠管尺寸原因更换吻合器,RY吻合组术中吻合器更换率高于裤形吻合组,但两组比较无意义(P>0.05)。裤形吻合组术后并发症总发生率低于RY吻合组(P<0.05)。裤形吻合组远期不良事件总发生率低于RY吻合组(P<0.05)。与术前比较,两组患者术后3个月、6个月营养评价指标TP、Hb、ALB、PNI均升高,且随着术后时间的延长逐渐升高(P<0.05),在两组术后指标比较中,裤形吻合组TP、Hb、ALB、PNI高于RY吻合组(P<0.05)。与术前比较,两组患者术后3个月、6个月生命质量QLQ-C30评分均升高,且随着术后时间的延长逐渐升高(P<0.05),在两组术后指标比较中,裤形吻合组生命质量QLQ-C30评分高于RY吻合组(P<0.05)。结论:与RY吻合的胃癌全胃切除后消化道重建方式比较,裤形吻合所带来的并发症较低,且裤形吻合在抗胆汁反流、反流性食管炎、食物排空障碍方面优于RY吻合,患者术后可获得更好的营养支持,患者生命质量显著提高,应用价值较高。

间置空肠代胃吻合术与Roux-en-Y代胃手术对患者术后生存质量的影响

目的:探讨间置空肠代胃吻合术(jejunal interposition pouch,JIP)与Roux-en-Y代胃手术对患者术后生存质量影响的差异性。方法:回顾性分析本院2006年至2011年收治的45例胃癌患者。按手术方式分为两组,即采用间置空肠代胃吻合术与Roux-en-Y代胃手术。记录其手术时间、住院天数、早期并发症与晚期并发症以及术后患者营养性指标,评估患者术后生存质量的差异性。结果:两组在手术时间、住院天数与早期并发症发生率之间的差异性无统计学意义(P>0.05),而间置空肠代胃吻合术后远期并发症的发生率明显低于Roux-en-Y术式,其术后1年的营养状况更是优于Roux-en-Y术式,差异具有统计学意义(P<0.05)。结论:间置空肠代胃吻合术相对于Roux-en-Y术式可以明显降低患者术后远期并发症的发生,且可以提高患者术后生存质量,值得推广。