陈洪义,
张新生^,,
张乾世,
冯震,
闫恩俊,
马浩日,
孙志威,
任双义
大连医科大学附属第二医院 胃肠外科, 辽宁 大连 116027

基金项目: 国家自然科学基金项目（81372669）；大连市科技创新基金项目（2018J13SN091）


详细信息 作者简介: 陈洪义(1993-), 男, 硕士研究生。E-mail:chenhongyi01@126.com








通讯作者: 张新生, 副主任医师。E-mail:zhangxs85@sina.com 中图分类号: R656.6⁺1


摘要:目的探讨全腹腔镜全胃切除的安全性、可行性，对比全腹腔镜下全胃切除食管空肠吻合应用Uncut Roux-en-Y吻合与π形吻合两种不同消化道重建方式的围手术期情况及术后疗效。方法回顾性分析2016年1月至2019年6月大连医科大学附属第二医院胃肠外科所有接受全腹腔镜根治性全胃切除75例胃癌患者的临床资料。根据消化道重建方式的不同，分为Uncut RY组（39例，52%）和π形吻合组（36例，48%）。比较两组患者的围手术期指标及术后并发症的发生情况。结果两组患者均顺利完成全腹腔镜下全胃切除手术，无中转开腹，无二次手术，无围手术期死亡。Uncut RY组与π形吻合组患者的手术时间分别为（215.10±35.71）min和（191.58±36.43）min，术后首次进食时间分别为3（2，4）d和4（3，6）d，上述两组数据比较，差异均有统计学意义（P < 0.05）；两组患者术中出血量、术后住院时间、住院费用等差异均无统计学意义（P>0.05）。Uncut RY组和π形吻合组Roux滞留综合征分别发生2例和8例，差异具有统计学意义（P < 0.05）；两组患者在吻合口漏、肺炎或胸腔积液、腹腔出血、切口感染、反流性食管炎、倾倒综合征、吻合口溃疡等术后并发症的发生方面，差异均无统计学意义（P>0.05）。结论全腹腔镜下全胃切除手术安全可行。应用π形吻合手术时间更短，应用Uncut Roux-en-Y吻合进食更早，Roux滞留综合征发生率更低。
关键词: 全腹腔镜/
全胃切除/
Uncut Roux-en-Y/
π形吻合


Abstract:ObjectiveTo compare the perioperative conditions and postoperative outcomes of total laparoscopic gastrectomy between Uncut Roux-en-Y anastomosis and π-shaped anastomosis.MethodsThe records of 75 gastric cancer patients underwent totally laparoscopic total gastrectomy in the Second Affiliated Hospital of Dalian Medical University from January 2016 to June 2019 were retrospectively analyzed. They were divided into Uncut RY group (39 cases, 52%) and π-shaped anastomosis group (36 cases, 48%). The perioperative and postoperative data of the two groups were compared.ResultsTotally laparoscopic total gastrectomy was successfully performed in both groups, without conversion to open surgery, no secondary surgery, and no perioperative death. The operation time in the Uncut RY group and the π-shaped anastomosis group were (215.10±35.71) min and (191.58±36.43) min, respectively. The first postoperative meal of patients in the Uncut RY group was shorter 3(2, 4) d than that in the π-shaped anastomosis group 4(3, 6) d. Intraoperative blood loss, postoperative hospital stay, and hospitalization costs were not different significantly between the two groups (P>0.05). There were 2 cases of Roux retention syndromes in the Uncut RY group and 8 cases in the π-shaped anastomosis group (P < 0.05). There was no significant difference in the incidence of postoperative complications such as anastomotic leakage, pneumonia or pleural effusion, abdominal bleeding, incision infection, reflux esophagitis, dumping syndrome, and anastomotic ulcers (P>0.05).ConclusionThe operation time was shorter in π-shaped anastomosis compared to that of Uncut Roux-en-Y anastomosis, but patients in the Uncut Roux-en-Y anastomosis group had earlier postoperative feeding, and low incidence of Roux retention syndrome.
Keywords:total laparoscopic/
total gastrectomy/
Uncut Roux-en-Y/
π-shaped anastomosis

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