非离断式Roux-en-Y吻合在腹腔镜根治性全胃切除术中的应用  

Effects of Un-cut Roux-en-Y Anastomosis in Laparoscopic Radical Total Gastrectomy for Gastric Cancer

作　　者：赵天天[1] 鲍传庆[1] 许炳华[1] 沈晓明[1] 杨增辉[1] Zhao Tiantian;Bao Chuanqing;Xu Binghua(Department of Gastrointestinal Surgery,Wuxi Third People's Hospital,Wuxi 214041,China)

机构地区：[1]无锡市第三人民医院胃肠外科,无锡214041

出　　处：《中国微创外科杂志》2018年第12期1095-1098,1107,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：无锡市卫计委科研面上项目(MS201612)

摘　　要：目的探讨非离断式Roux-en-Y吻合方式与传统Roux-en-Y吻合方式应用于腹腔镜根治性全胃切除术中消化道重建的临床疗效。方法回顾性分析2013年8月～2017年8月我院76例腹腔镜根治性全胃切除且有完整随访的临床资料,按消化道重建方式不同分为非离断式Roux-en-Y吻合(Un-cut RY组,n=25)和传统食管空肠Roux-en-Y吻合(RY组,n=51)。比较2组手术时间、出血量、术后住院时间、并发症、术后营养指标以及术后生存等情况。结果 Un-cut RY组术中出血量明显少于RY组[(230. 7±65. 2) ml vs.(292. 0±78. 6) ml,t=-3. 369,P=0. 001];肛门恢复排气时间明显短于RY组[(52. 8±9. 6) h vs.(61. 4±10. 8) h,t=-3. 379,P=0. 001]。2组反流性食管炎[12. 0%(3/25) vs. 9. 8%(5/51),χ~2=0. 000,P=1. 000]、倾倒综合征发生率[0. 0%(0/25) vs. 3. 9%(2/51),Fisher精确检验,P=1. 000]和食物襻排空延迟或障碍[4. 0%(1/25) vs. 23. 5%(12/51),χ~2=3. 240,P=0. 072]差异均无显著性。Un-cut RY组RY滞留综合征发生率[0. 0%(0/25) vs. 21. 6%(11/51),Fisher精确检验,P=0. 013]明显低于RY组。2组术后3个月BMI变化[0. 81±0. 37 vs. 0. 88±0. 13,t=1. 191,P=0. 123]、血红蛋白变化[(8. 6±2. 5) g/L vs.(9. 3±3. 6) g/L,t=0. 873,P=0. 195]、白蛋白变化[(3. 5±1. 4) g/L vs.(3. 7±1. 8) g/L,t=0. 487,P=0. 316]和总蛋白变化[(4. 6±1. 7) g/L vs.(5. 2±1. 9) g/L,t=1. 037,P=0. 167]差异均无显著性。2组生存率无显著差异(χ~2=0. 418,P=0. 518)。结论非离断式Roux-en-Y吻合有保持肠道连续性和手术相对简单的优势,缩短术后肛门恢复排气时间,减少术后RY滞留综合征,并不影响术后的营养状况和生存情况,是临床上值得推广的一种消化道重建方式。Objective To investigate the clinical efficacy of un-cut Roux-en-Y anastomosis and traditional Roux-en-Y anastomosis in the treatment of digestive tract reconstruction in laparoscopic radical total gastrectomy for gastric cancer.Methods A retrospective analysis was made on 76 cases of laparoscopic total radical surgery for gastric cancer from August 2013 to August 2017 in our hospital.According to different digestive tract reconstruction methods,they were divided into un-cut Roux-en-Y anastomosis group(Un-cut RY group,25 cases)and traditional esophageal jejunal Roux-en-Y anastomosis group(RY group,51 cases).The operative time,bleeding volume,postoperative hospital stay,complication,nutritional index and postoperative survival data were compared between the two groups.Results The intraoperative bleeding quantity of Un-cut RY group was significantly less than that of RY group[(230.7±65.2)ml vs.(292.0±78.6)ml,t=-3.369,P=0.001];the restoration of anal exhaust time of Un-cut RY group was significantly shorter than that of RY group[(52.8±9.6)h vs.(61.4±10.8)h,t=-3.379,P=0.001];the reflux esophagitis[12.0%(3/25)vs.9.8%(5/51),χ^2=0.000,P=1.000],dumping syndrome incidence rate[0.0%(0/25)vs.3.9%(2/51),Fisher’s exact test,P=1.000],and intestinal emptying delay or disorder[4.0%(1/25)vs.23.5%(12/51),χ^2=3.240,P=0.072]had no differences between the two groups.The RY stasis syndrome(RSS)incidence of Un-cut RY group was significantly lower than that of RY group[0.0%(0/25)vs.21.6%(11/51),Fisher’s exact test,P=0.013].At 3 months after surgery,there were no differences between the two groups in BMI[0.81±0.37 vs.0.88±0.13,t=1.191,P=0.123],hemoglobin[(8.6±2.5)g/L vs.(9.3±3.6)g/L,t=0.873,P=0.195],albumin[(3.5±1.4)g/L vs.(3.7±1.8)g/L,t=0.487,P=0.316],and total protein and prognosis[(4.6±1.7)g/L vs.(5.2±1.9)g/L,t=1.037,P=0.167].There was also no significant difference in survival curves between the two groups(χ^2=0.418,P=0.518).Conclusions Un-cut Roux-en-Y anastomosis maintains the advantages of intestinal continuity,

关 键 词：非离断式Roux-en-Y吻合 腹腔镜 根治性全胃切除术 

分 类 号：R735.2[医药卫生—肿瘤]