腹腔镜辅助远端胃癌根治术中非离断式Roux-en-Y吻合的效果观察  

Effect observation of uncut Roux-en-Y anastomosis in laparoscopic assisted radical gastrectomy for distal gastric cancer

作　　者：王刚[1] 李玉庆 李云川[1] 杜明新 李强[1] Wang Gang;Li Yuqing;Li Yunchuan;Du Mingxin;Li Qiang(Department of General Surgery 2,Tangshan Union Medical College Hospital of Hebei Province,Tangshan 063000,China;Department of Emergency,Tangshan Union Medical College Hospital of Hebei Province,Tangshan 063000,China;Supply Department,Tangshan Union Medical College Hospital of Hebei Province,Tangshan 063000,China)

机构地区：[1]河北省唐山市协和医院普外二科,063000 [2]河北省唐山市协和医院急诊科,063000 [3]河北省唐山市协和医院供应室

出　　处：《中国综合临床》2021年第5期415-419,共5页Clinical Medicine of China

基　　金：河北省医学科学研究课题计划 (20210941)。

摘　　要：目的探讨非离断式Roux-en-Y吻合在腹腔镜辅助远端胃癌根治术中应用的疗效。方法回顾性分析2016年5月至2019年10月唐山市协和医院53例经手术治疗的远端胃癌患者的临床资料,手术方式为腹腔镜辅助远端胃癌根治术,吻合方式为非离断式Roux-en-Y吻合29例(非离断组)和Roux-en-Y吻合24例(传统组),比较两组患者手术时间、消化道重建时间、术后排气时间、术后住院时间、主要并发症情况及术后患者1年内的随访结果。结果非离断组手术时间为(196.0±28.8) min、吻合时间为(56.1±13.8) min、术后排气时间为(52.5±14.4) h、术后住院时间为(12.5±2.8) d,传统组分别为(201.0±28.5) min、(57.8±12.9) min、(53.9±14.6) h、(12.0±3.0) d,两组比较差异均无统计学意义(P值分别为0.534、0.664、0.717、0.557)。术后并发症情况:非离断组吻合口漏为0(0/29)、腹腔出血为3.4%(1/29)、碱性反流性胃炎为6.9%(2/29),传统组分别为4.2%(1/24)、4.2%(1/24)、4.2%(1/24),两组比较差异均无统计学意义(P值分别为0.453、1.000、1.000);非离断组Roux-en-Y滞留综合征发生率为0(0/29),传统组为25.0%(6/24),两组比较差异有统计学意义(P=0.006)。1例非离断组患者术后8个月发现输入袢再通,患者经再次开腹手术,吻合方式改为传统的Roux-en-Y吻合,患者术后反酸、烧心等反流症状明显好转。均未发生十二指肠残端漏、吻合口溃疡等并发症。结论作为远端胃癌根治术的消化道重建方式,非离断式Roux-en-Y吻合方式是安全可行的,能避免Roux-en-Y滞留综合征。Objective To investigate the effect of uncut Roux-en-Y anastomosis in laparoscopic assisted radical gastrectomy for distal gastric cancer.Methods The clinical data of 53 patients with distal gastric cancer treated by surgery in Tangshan Union Medical College Hospital from May 2016 to October 2019 were analyzed retrospectively.The operation method was laparoscopic assisted radical gastrectomy for distal gastric cancer.The anastomosis methods were uncut Roux-en-Y anastomosis in 29 cases(uncut group)and Roux-en-Y anastomosis in 24 cases(traditional group).The operation time,digestive tract reconstruction time,the time to flatus,length of hospital stay,incidence of complication and one year followed up results were compared between the two groups.Results The operation time was(196.0±28.8)min,anastomotic time was(56.1±13.8)min,postoperative exhaust time was(52.5±14.4)h,postoperative hospital stay was(12.5±2.8)d in the uncut group,and(201.0±28.5)min,(57.8±12.9)min,(53.9±14.6)h,(12.0±3.0)d in the traditional group.There was no significant difference between the two groups(P values were 0.534,0.664,0.717 and 0.557,respectively).Postoperative complications:anastomotic leakage was 0(0/29),abdominal bleeding was 3.4%(1/29),alkaline reflux gastritis was 6.9%(2/29)in the uncut group and 4.2%(1/24),4.2%(1/24)and 4.2%(1/24)in the traditional group respectively.There was no significant difference between the two groups(P values were 0.453,1.000 and 1.000,respectively).The incidence of Roux-en-Y stasis syndrome was 0(0/29)in the uncut group and 25.0%(6/24)in the traditional group.There was significant difference between the two groups(P=0.006).One case in the uncut group was found recanalization 8 months after operation,the patient underwent reoperation,the method of anastomosis was changed to traditional Roux-en-Y anastomosis.The patient′s symptoms of reflux and hearburn improved significantly after operation.Conclusion As a digestive tract reconstruction method for radical gastrectomy of distal gastric cancer,uncut Ro

关 键 词：胃癌 远端胃癌根治术 非离断式Roux-en-Y吻合 腹腔镜 消化道重建 

分 类 号：R735.2[医药卫生—肿瘤]