反穿刺与Overlap在全腹腔镜根治性全胃切除术食管空肠吻合中的对比研究  

Comparison of reverse puncture device and Overlap in laparoscopic total gastrectomy for gastric cancer

作　　者：陈成[1] 魏猛[1] 韩海峰[1] 孙丹平 刘鹏 钟鑫 安炳政 于文滨[1] CHEN Cheng;WEI Meng;HAN Hai-feng(Department of General Surgery,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院

出　　处：《腹腔镜外科杂志》2020年第1期25-29,共5页Journal of Laparoscopic Surgery

基　　金：横向课题(6010119083)

摘　　要：目的:研究对比反穿刺与Overlap在全腹腔镜根治性全胃切除术食管空肠吻合中的应用价值。方法:回顾分析接受全腹腔镜根治性全胃切除术的134例胃癌患者的临床资料,按食管空肠吻合方法分为两组,反穿刺组(n=77)与Overlap组(n=57)。对比分析两组患者一般资料、术中与术后情况。结果:两组患者在年龄、体重指数、手术时间、吻合时间、出血量、术后住院时间、肿瘤位置、肿瘤大小、肿瘤分化程度、肿瘤Borrmann分型、总淋巴结数量、阳性淋巴结数量、住院费用、术中并发症、术后并发症等方面差异无统计学意义。在肿瘤上缘至食管切缘距离方面,反穿刺组长于Overlap组。结论:反穿刺与Overlap在食管空肠吻合术中均是安全、有效的,但反穿刺更能获得足够的近端阴性切缘距离,更适合位置较高的胃食管结合部肿瘤。Objective:To compare the application of reverse puncture device(RPD)and Overlap technique in esophagojejunostomy in totally laparoscopic total gastrectomy.Methods:A retrospective study was conducted on 134 gastric cancer patients who underwent totally laparoscopic total gastrectomy.According to different methods of esophagojejunostomy,patients were divided into two groups:RPD group(n=77)and Overlap group(n=57).The differences in demographics,intra-and postoperative conditions between two groups were compared.Results:There was no significant difference in age,BMI,duration of surgery,duration of anastomosis,blood loss,postoperative hospital stay,tumor location,tumor size,degree of tumor differentiation,Borrmann type,total number of lymph nodes,number of positive lymph nodes,hospitalization costs,intraoperative complications and postoperative complications between the two groups.However,the distance between the upper edge of the tumor and the cutting edge of the esophagus was significantly longer in the RPD group.Authors further compared the data of the two groups on gastroesophageal junction cancer,and found that the distance between the upper margin of the tumor and the cutting edge of the esophagus in the RPD group was significantly longer than the other.Conclusions:Both RPD and Overlap technique are safe and effective in esophagojejunostomy,but RPD is easier to obtain sufficient proximal negative surgical margin.Therefore,RPD is more suitable for patients with gastroesophageal junction cancer with a higher location.

关 键 词：胃肿瘤 胃切除术 食管空肠吻合术 腹腔镜检查 对比研究 

分 类 号：R735.2[医药卫生—肿瘤]