三角吻合术在腹腔镜远端胃切除术后消化道重建中的应用价值  

Application value of triangle anastomosis in digestive tract reconstruction after laparoscopic distal gastrectomy

作　　者：申旭旗 付歆颖[1] 黄连顺 赵永亮 SHEN Xuqi;FU Xinying;HUANG Lianshun;ZHAO Yongliang(The First Department of Surgery,the 478th Hospital of PLA,Kunming,Yunnan 650202,China;General Surgery Center,Southowest Hospital of the Army Military Medical University,Chongqing 400038,China)

机构地区：[1]解放军第478医院外一科,昆明650202 [2]陆军军医大学西南医院全军普通外科中心,重庆400038

出　　处：《重庆医学》2021年第6期932-936,共5页Chongqing medicine

基　　金：国家自然科学基金项目(81872016)。

摘　　要：目的探讨三角吻合术在全腹腔镜远端胃切除术后消化道重建中的应用价值。方法选择2015年1月至2018年6月在解放军478医院就诊的98例远端胃癌患者,患者均进行了远端胃切除术,按不同消化道重建方式分为观察组和对照组。其中观察组46例患者于腹腔镜下使用三角吻合术进行消化道重建,对照组52例患者于腹腔镜下行Billroth-Ⅰ式吻合(毕Ⅰ式吻合)进行消化道重建。对两组患者手术相关指标、术后生化指标及术后随访半年并发症发生率等计量资料进行统计比较。结果观察组手术时间、出血量、切口长度、术后排气时间、术后首次进流食时间和住院时间均较对照组缩短,组间比较差异有统计学意义(P<0.05)。两组患者术后半年血清总蛋白(TP)、清蛋白(Alb)、血红蛋白(Hb)及BMI下降幅度比较差异无统计学意义(P>0.05)。观察组与对照组术后并发症总发生率分别为13.0%和15.4%,两组比较差异无统计学意义(P>0.05)。两组患者术后均未出现吻合口狭小、肿瘤复发和死亡情况。结论与全腹腔镜行毕Ⅰ式吻合比较,三角吻合术更具有微创性优势,术中出血量降低,手术时间缩短,效果更佳,恢复更快,是一种更为安全、有效的手术方式。Objective To explore the application of triangular anastomosis in digestive tract reconstruction after laparoscopic distal gastrectomy for gastric cancer.Methods A total of 98 patients with distal gastric cancer who were treated in the 478 th Hospital of the PLA from January 2015 to June 2018 were selected.All patients underwent laparoscopic distal gastrectomy and were divided into the observation group and the control group according to different digestive tract reconstruction methods.Among them,46 patients in the observation group who underwent laparoscopic triangular anastomosis for digestive tract reconstruction,and 52 patients in the control group who underwent laparoscopic Billroth-Ⅰanastomosis(BillⅠanastomosis)for digestive tract reconstruction.Statistical comparisons were made between the two groups of patients on surgicalrelated indicators,postoperative biochemical indicators,and the incidence of complications in six months after operation.Results The operation time,blood loss,incision length,postoperative exhaust time,first fluid feeding time and hospital stay in the observation group were shorter than those in the control group,and the differences between the two groups were statistically significant(P<0.05).There was no statistically significant difference in the reduction of serum total protein(TP),albumin(Alb),hemoglobin(Hb)and BMI between the two groups of patients at the time of six months after surgery(P>0.05).The total incidence of postoperative complications in the observation group and the control group were 13.0%and 15.4%,respectively,and there was no statistically significant difference between the two groups(all P>0.05).There was no anastomotic narrow,tumor recurrence,or death in either group during follow-up period.Conclusion Compared with the full laparoscopic BillⅠanastomosis,the triangular anastomosis has more minimally invasive advantage,less bleeding and operation time,better results,faster recovery,and has a certain promotion value.

关 键 词：三角吻合术 胃肿瘤 腹腔镜检查 远端胃切除术 消化道重建 

分 类 号：R735.2[医药卫生—肿瘤]