腹腔镜下根治性全胃切除术中两种食管空肠吻合方式与并发症关系  

Relationship between mode of esophagojejunostomy in laparoscopic radical total gastrectomy and complications

作　　者：王超珺[1] 张思宇[1] 黄小蓉[1] 

机构地区：[1]厦门大学附属第一医院普外科,福建省厦门市361003

出　　处：《世界华人消化杂志》2016年第8期1252-1256,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨在腹腔镜下采用Roux-en-Y式食管空肠吻合与Lahey-Braun式食管空肠吻合对根治性全胃切除术术中情况及术后并发症的影响.方法:回顾性分析厦门大学附属第一医院普外科自2011-01/2014-01收治的行腹腔镜下根治性全胃切除术且食管空肠吻合采用Roux-en-Y式吻合的患者81例和采用LaheyBraun式吻合的患者89例的临床资料,评价并比较Roux-en-Y组和Lahey-Braun组患者的总手术时间、术中出血量、术后肛门恢复排气时间和恢复进食时间,术后随访总并发症发生率、反流性食管炎发生率、吻合口出血率、吻合口瘘发生率.结果:170例患者均成功施行腹腔镜下根治性全胃切除术,Roux-en-Y组患者术中出血量低于Lahey-Braun组术中出血量(120.8 mL±21.3 mL vs 131.1 mL±16.4 mL,P<0.05),Roux-en-Y组患者术后肛门恢复排气时间短于Lahey-Braun组术中(2.1 d±1.3 d vs 2.6 d±1.4 d,P<0.05);Roux-en-Y组患者并发症总发生率低于Lahey-Braun组并发症总发生率(34.6%vs 59.6%,P<0.01);Roux-en-Y组患者反流性食管炎发生率低于Lahey-Braun组并发症总发生率(22.2%vs 52.8%,P<0.01);其他指标组间比较,差异无显著统计学意义.结论:腹腔镜下根治性全胃切除术中食管空肠吻合采取Roux-en-Y吻合及Lahey-Braun吻合,两种吻合方式在安全性及术后恢复中效果基本相同,但术后Roux-en-Y吻合反流性食管炎的发生率明显低于Lahey-Braun吻合.AIM： To analyze the relationship between mode of esophagojejunostomy in laparoscopic radical total gastrectomy and complications.METHODS： The clinical data for 89 patients who underwent Roux-en-Y anastomosis and 81 patients who underwent Lahey-Braun anastomosis in laparoscopic radical total gastrectomy at our hospital from January 2011 to January 2014 were analyzed retrospectively. Total operative time, blood loss, time to postoperative anal exhaust, time to recovery of food intake, overall complication rate, and rates of reflux esophagitis, anastomotic bleeding and anastomotic fistula were compared between the Roux-en-Y group and the Lahey-Braun group.RESULTS： Laparoscopic radical total gastrectomy was successful in all the 170 patients. Blood loss was significantly less in the Roux-en-Y group than in the Lahey-Braun group （120.8 mL ±21.3 mL vs 131.1 mL ±16.4 mL, P 〈 0.05）. Time to postoperative anal exhaust was statistically shorter in the Roux-en-Y group than in the Lahey-Braun group （2.1 d± 1.3 d vs 2.6 d ± 1.4 d, P 〈 0.05）. Total complication rate was statistically lower in the Roux-en-Y group than in the Lahey-Braun group （34.6% vs 59.6%, P 〈 0.01）. Incidence of reflux esophagitis was statistically lower in the Roux-en-Y group than in the Lahey-Braun group （22.2% vs 52.8%, P 〈 0.01）. There were no significant differences in other indicators between the two groups.Lahey-Braun anastomosis and Roux-en-Y anastomosis in laparoscopic radical total gastrectomy are basically same. However, the incidence of reflux esophagitis in Roux-en-Y anastomosis is significantly lower than that in Lahey-Braun anastomosis.

关 键 词：腹腔镜下根治性全胃切除术 ROUX-EN-Y吻合 Lahey-Braun吻合 并发症 

分 类 号：R735.2[医药卫生—肿瘤]