腹腔镜全胃切除术应用不同食管空肠吻合法临床疗效分析  

Clinical analysis of laparoscopic total gastrectomy for different esophageal jejunal anastomosis

作　　者：黄牛[1] 王昕[1] 朱雄兵[1] 

机构地区：[1]湖北省咸宁市通城县人民医院胃肠外科,437400

出　　处：《中华普通外科学文献（电子版）》2017年第6期410-413,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜全胃切除术(TLTG)应用不同的食管空肠吻合方法的临床疗效。方法回顾性分析2011年10月到2016年7月间咸宁市通城县人民医院行TLTG的425例患者,根据不同食管空肠吻合方法将患者分为端侧吻合组、侧吻合组、三角吻合组、手工缝合组,对各组患者围手术期临床资料(包括手术时间、吻合时间、术后进食、并发症发生率等)进行比较分析。结果425例TLTG患者术前ASA分级Ⅰ级219例,Ⅱ级192例,Ⅲ级14例。各组患者的ASA、淋巴结清扫数目等差异均无统计学意义。各组围手术期无死亡患者,其中手工缝合组的术后并发症发生率为7.5%,明显低于端侧吻合组的25.3%、侧吻合组的22.6%、三角吻合组的11.1%,差异有统计学意义(P<0.05)。四组患者的手术时长、吻合所需时间以及术后进食等指标差异无统计学意义,手工缝合组患者术中出血量、排气时间以及住院天数与其他三组相比明显减少,差异有统计学意义(F=5.744、4.325、5.687,P=0.032、0.025、0.021)。结论腹腔镜全胃切除术具有创伤小、出血少、术后恢复快等优点,应用不同食管空肠吻合方法的临床效果各有利弊,其中腹腔镜直视手工缝合法相对更为安全可行。Objective To evaluate the clinical efficacy of totally laparoscopic total gastrectomy （TLTG） with different methods of esophageal and jejunal anastomosis. Methods A retrospective analysis of four hundred and twenty-five patients with TLTG in Tongcheng County People＆#39;s Hospital of Xianning from October 2011 to July 2016 was performed. The patients were divided into the end to side anastomosis group （Group A）, the side anastomosis group （Group B）, the triangle anastomosis group （Group C） and the manual suture group （Group D）, according to different methods of the anastomosis of the esophagus and jejunum. The clinical data including operation time, time of anastomosis, postoperative eating and complication rate were compared and analyzed. Results Preoperative ASA classification divided the 425 patients into 219 of grade Ⅰ , 192 of grade Ⅱ , 14 of grade Ⅲ . There were no significant differences on ASA and the number of lymph node among four groups. No deaths occurred during the perioperative period. The complication rate of Group D was 7.5%, which was lower than 25.3% of Group A, 22.6% of Group B and 11.1% of Group C, the difference was statistically significant （P〈0.05）. There was no significant difference among the four groups in the length of operation, the time required for the anastomosis and the postoperative feeding. The amount of bleeding, time of exhaust and length of hospital stay in Group D were significantly shorter than those of the other three groups （F=5.744, 4.325, 5.687, P=0.032, 0.025, 0.021）. Conclusions TLTG has the advantages of less trauma, less bleeding and quick recovery after operation. There are advantages and disadvantages in the clinical application of different methods of esophageal and jejunal anastomosis, among which laparoscopic manual suture is relatively safe and feasible.

关 键 词：胃切除术 腹腔镜 吻合术 Roux—en—Y 

分 类 号：R735.2[医药卫生—肿瘤]