完全腹腔镜下全胃切除食管空肠π型吻合和辅助切口Roux-en-Y吻合的临床疗效对比
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摘要
目的比较食管空肠π型吻合与辅助切口Roux-en-Y吻合在腹腔镜全胃切除术中的临床疗效,探讨π型吻合技术在完全腹腔镜全胃切除术中的安全性及可行性。方法收集分析我院2016年12月～2017年12月的40例全胃切除术中实施完全腔镜下食管空肠π型吻合的患者(π组)和45例接受辅助切口Roux-en-Y吻合的患者(Roux-en-Y组)的临床资料,然后对比分析两组患者的术中指标以及术后指标,借此来评判两组的治疗效益。结果 85例全胃切除手术均顺利完成手术。π组的切口长度、饮食流质时间、下床活动及住院时间及术后疼痛评分均优于Roux-en-Y组(P<0.05)。两组的术中出血量、吻合完成时间、清除的淋巴结总量以及总费用对比无明显差别(P>0.05)。Roux-en-Y组术后并发症发生率15.6%(7/45),π组术后并发症发生率5%(2/40),两组对比无统计学差异(P>0.05)。结论食管空肠π型吻合在腔镜全胃切除术中应用安全可靠且近期效益满意,与传统Roux-en-Y吻合相比具有痊愈快、住院天数少、腹壁创伤小,术后疼痛轻等优势,初步观察结果是一种值得推广的吻合手段。
Objective To compare the clinical effect of π-Shaped esophagojejunostomy and auxiliary incision Roux-en-Y anastomosis in laparoscopic total gastrectomy, and to explore the safety and feasibility of π-Shaped anastomosis in complete laparoscopic total gastrectomy. Methods From December 2016 to December 2017, 40 patients underwent complete laparoscopic π-Shaped esophagojejunostomy(π group) and 45 patients who underwent an auxiliary incision Roux-en-Y anastomosis(Roux-en-Y group). Then compare the intraoperative and postoperative indexes of the two groups to evaluate the therapeutic effects of the two groups. Results All procedures were completed successfully. The incision length, the time to fluid diet,the off-bed time and the hospital stay, and postoperative pain scores in the π group were superior to those in the Roux-en-Y group(P <0.05). However there were no significant difference in intraoperative blood loss,the time of anastomosis, the number of cleared lymph nodes, and total cost between the two groups(P>0.05).The incidence of postoperative complications was 15.6%(7/45) in the Roux-en-Y group and 5%(2/40) in the π group. There was no significant difference between the two groups(p>0.05). Conclusion π-Shaped esophagojejunostomy is safe and reliable in complete laparoscopic total gastrectomy,and the short-term benefits are satisfactory. Compared with traditional Roux-en-Y anastomosis, it has the advantages of quick recovery, less hospitalization, less abdominal wall trauma and light postoperative pain. Preliminary observation show that π-Shaped is an anastomotic means worth promoting.
Objective To compare the clinical effect of π-Shaped esophagojejunostomy and auxiliary incision Roux-en-Y anastomosis in laparoscopic total gastrectomy, and to explore the safety and feasibility of π-Shaped anastomosis in complete laparoscopic total gastrectomy. Methods From December 2016 to December 2017, 40 patients underwent complete laparoscopic π-Shaped esophagojejunostomy(π group) and 45 patients who underwent an auxiliary incision Roux-en-Y anastomosis(Roux-en-Y group). Then compare the intraoperative and postoperative indexes of the two groups to evaluate the therapeutic effects of the two groups. Results All procedures were completed successfully. The incision length, the time to fluid diet,the off-bed time and the hospital stay, and postoperative pain scores in the π group were superior to those in the Roux-en-Y group(P <0.05). However there were no significant difference in intraoperative blood loss,the time of anastomosis, the number of cleared lymph nodes, and total cost between the two groups(P>0.05).The incidence of postoperative complications was 15.6%(7/45) in the Roux-en-Y group and 5%(2/40) in the π group. There was no significant difference between the two groups(p>0.05). Conclusion π-Shaped esophagojejunostomy is safe and reliable in complete laparoscopic total gastrectomy,and the short-term benefits are satisfactory. Compared with traditional Roux-en-Y anastomosis, it has the advantages of quick recovery, less hospitalization, less abdominal wall trauma and light postoperative pain. Preliminary observation show that π-Shaped is an anastomotic means worth promoting.
引文
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[4] Kunisaki C, Makino H, Takagawa R, et al. A systematic review of laparoscopic total gastrectomy for gastric cancer[J].Gastric Cancer,2015,18(2):218-26.
[5]杨力,徐泽宽,徐皓,等.胃癌全腹腔镜下全胃切除食管空肠π形吻合临床体会[J].中华胃肠外科杂志,2016,19(8):948-950.
[6] Kwon IG, Son YG, Ryu SW. Novel Intracorporeal Esophagojejunostomy Using Linear Staplers During Laparoscopic Total Gastrectomy:π-Shaped Esophagojejunostomy, 3-in-1 Technique.[J].J Am Coll Surg,2016,223(3):e25-9.
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[8]刘尚龙,周岩冰.胃癌围手术期加速康复外科理念指导下的规范化管理[J].中华胃肠外科杂志,2015(2):116-120.
[9] Yamamoto M, Kawano H, Yamaguchi S, et al. Technical and Survival Risks Associated With Esophagojejunostomy by Laparoscopic Total Gastrectomy for Gastric Carcinoma[J].SurgLaparose Endosc Percutan Tech,2017,27(3):197-202.
[10] Chen G, Xu X, Gong J, et al.[Safety and efficacy of hand-assisted laparoscopic versus open distal gastrectomy for gastric cancer:A systematic review and meta-analysis][J].Zhonghua Wei Chang Wai Ke Za Zhi, 2017,20(3):320-325.
[11]申腾飞.胃癌根治性全胃切除uncut Roux-en-Y吻合的应用研究[D].郑州大学,2017.
[12] Hong Q, Cai XJ, Wang Y, et al.[The research on the application of uncut Roux-en-Y esophagojejunostomy in the digestive reconstruction after totally laparoscopic total gastrectomy][J].Zhonghua Yi Xue Za Zhi, 2018,98(28):2254-2257.
[13]高万露,汪小海.患者疼痛评分法的术前选择及术后疼痛评估的效果分析[J].实用医学杂志,2013,(23):3892-3894.
[14]杨力,徐泽宽,徐皓,等.食管空肠π吻合在全腹腔镜全胃切除术中的应用价值[J].中华消化外科杂志,2017,16(5):522-526.
[15]余佩武,赵永亮.全腹腔镜全胃切除术消化道重建方式选择及技术要点[J].中国实用外科杂志,2016,(09):942-945.
[16] Xu QR, Wang KN, Wang WP, et al. Linear stapled esophagogastrostomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture:a comparative clinical study[J].J Gastrointest Surg, 2011,15(6):915-21.
[2] Moisan F, Norero E,Slako M,et al. Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer:a matched cohort study[J].Surg Endosc, 2012,26(3):661-72.
[3]王林俊,徐皓,徐泽宽.全腹腔镜胃癌根治术消化道重建方法选择与评价[J].中华胃肠外科杂志,2017,20(10):1113-1116.
[4] Kunisaki C, Makino H, Takagawa R, et al. A systematic review of laparoscopic total gastrectomy for gastric cancer[J].Gastric Cancer,2015,18(2):218-26.
[5]杨力,徐泽宽,徐皓,等.胃癌全腹腔镜下全胃切除食管空肠π形吻合临床体会[J].中华胃肠外科杂志,2016,19(8):948-950.
[6] Kwon IG, Son YG, Ryu SW. Novel Intracorporeal Esophagojejunostomy Using Linear Staplers During Laparoscopic Total Gastrectomy:π-Shaped Esophagojejunostomy, 3-in-1 Technique.[J].J Am Coll Surg,2016,223(3):e25-9.
[7]黄昌明,陆俊.腹腔镜胃癌根治术规范化实施值得关注的问题[J].中国实用外科杂志,2014(7):616-619.
[8]刘尚龙,周岩冰.胃癌围手术期加速康复外科理念指导下的规范化管理[J].中华胃肠外科杂志,2015(2):116-120.
[9] Yamamoto M, Kawano H, Yamaguchi S, et al. Technical and Survival Risks Associated With Esophagojejunostomy by Laparoscopic Total Gastrectomy for Gastric Carcinoma[J].SurgLaparose Endosc Percutan Tech,2017,27(3):197-202.
[10] Chen G, Xu X, Gong J, et al.[Safety and efficacy of hand-assisted laparoscopic versus open distal gastrectomy for gastric cancer:A systematic review and meta-analysis][J].Zhonghua Wei Chang Wai Ke Za Zhi, 2017,20(3):320-325.
[11]申腾飞.胃癌根治性全胃切除uncut Roux-en-Y吻合的应用研究[D].郑州大学,2017.
[12] Hong Q, Cai XJ, Wang Y, et al.[The research on the application of uncut Roux-en-Y esophagojejunostomy in the digestive reconstruction after totally laparoscopic total gastrectomy][J].Zhonghua Yi Xue Za Zhi, 2018,98(28):2254-2257.
[13]高万露,汪小海.患者疼痛评分法的术前选择及术后疼痛评估的效果分析[J].实用医学杂志,2013,(23):3892-3894.
[14]杨力,徐泽宽,徐皓,等.食管空肠π吻合在全腹腔镜全胃切除术中的应用价值[J].中华消化外科杂志,2017,16(5):522-526.
[15]余佩武,赵永亮.全腹腔镜全胃切除术消化道重建方式选择及技术要点[J].中国实用外科杂志,2016,(09):942-945.
[16] Xu QR, Wang KN, Wang WP, et al. Linear stapled esophagogastrostomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture:a comparative clinical study[J].J Gastrointest Surg, 2011,15(6):915-21.