十二指肠残端加固对腹腔镜胃癌根治术患者术后并发症的影响  

Effect of duodenal stump reinforcement on postoperative complications in patients undergoing laparoscopic radical gastrectomy

作　　者：燕明 李政焰 林夏 叶小双 钱锋 石彦 赵永亮 Ming Yan;Zhengyan Li;Xia Lin;Xiaoshuang Ye;Feng Qian;Yan Shi;Yongliang Zhao(Department of General Surgery,the First Hospital Affiliated to Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院普通外科,重庆400038

出　　处：《中华胃肠外科杂志》2022年第7期590-595,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的评估十二指肠残端加固对腹腔镜胃癌根治术患者术后近期发生并发症的影响。方法采用倾向评分匹配和回顾性队列研究的方法。收集陆军军医大学第一附属医院2009年4月至2018年12月期间,行腹腔镜胃癌根治术的1204例胃癌患者的临床资料,消化道重建方式为毕Ⅱ式吻合、Roux-en-Y吻合或非离断Roux-en-Y吻合,采用直线切割吻合器离断胃与十二指肠。男性838例,女性366例,年龄(57.0±16.0)岁;术中对十二指肠残端进行加固处理者792例(加固组),不加固处理412例(未加固组)。两组患者手术切除范围和吻合方式差异存在统计学意义(均P<0.001)。两组患者按1∶1比例进行倾向性评分匹配,并进一步将加固组分为荷包包埋组和非荷包包埋组。主要观察指标为术后近期(术后1个月)并发症的发生情况,将Clavien-Dindo分级≥Ⅲa级的并发症定义为严重并发症,并对加固组与未加固组以及荷包包埋组与非荷包包埋组的并发症发生率进行比较。结果倾向性评分匹配后,两组各纳入患者411例,两组患者基线资料的比较差异均无统计学意义(均P>0.05)。全组患者无围手术期死亡。术后近期总体并发症发生率为7.4%(61/822),出现并发症的61例患者中,吻合口漏14例(23.0%),腹腔出血11例(18.0%),十二指肠残端漏8例(13.1%),切口裂开2例(3.3%)、切口感染6例(9.8%)和腹腔感染20例(32.8%);加固组与未加固组分别有25例(6.1%)和36例(8.8%)发生术后近期并发症,两组比较,差异无统计学意义(χ^(2)=2.142,P=0.143)。全组患者术后近期发生≥Ⅲa级的严重并发症19例(19/822,2.3%),两组严重并发症发生率[1.7%(7/411)比2.9%(12/411)]比较,差异也无统计学意义(χ^(2)=1.347,P=0.246)。亚组分析显示,荷包包埋组术后近期并发症发生率2.6%(9/345),明显低于非荷包包埋组的24.2%(16/66),差异有统计学意义(χ^(2)=45.388,P<0.001)。结论常规加固十二指肠残端并未显著降低十Objective To evaluate the influence of duodenal stump reinforcing on the short-term complications after laparoscopic radical gastrectomy.Methods A retrospective cohort study with propensity score matching(PSM)was conducted.Clinical data of 1204 patients with gastric cancer who underwent laparoscopic radical gastrectomy at the First Affiliated Hospital of Army Medical University from April 2009 to December 2018 were collected.The digestive tract reconstruction methods included Billroth II anastomosis,Roux-en-Y anastomosis and un-cut-Roux-en-Y anastomosis.A linear stapler was used to transected the stomach and the duodenum.Among 1204 patients,838 were males and 366 were females with mean age of(57.0±16.0)years.Duodenal stump was reinforced in 792 cases(reinforcement group)and unreinforced in 412 cases(non-reinforcement group).There were significant differences in resection range and anastomotic methods between the two groups(both P<0.001).The two groups were matched by propensity score according to the ratio of 1∶1,and the reinforcement group was further divided into purse string group and non-purse string group.The primary outcome was short-term postoperative complications(within one month after operation).Complications with Clavien-Dindo grade≥III a were defined as severe complications,and the morbidity of complication between the reinforcement group and the non-reinforcement group,as well as between the purse string group and the non-purse string group was compared.Results After PSM,411 pairs were included in the reinforcement group and the non-reinforcement group,and there were no significant differences in baseline data between the two groups(all P>0.05).No perioperative death occurred in any patient.The short-term morbidity of postoperative complication was 7.4%(61/822),including 14 cases of anastomotic leakage(23.0%),11 cases of abdominal hemorrhage(18.0%),8 cases of duodenal stump leakage(13.1%),2 cases of incision dehiscence(3.3%),6 cases of incision infection(9.8%)and 20 cases of abdominal infection(

关 键 词：胃肿瘤 腹腔镜手术 十二指肠残端包埋 十二指肠残端漏 并发症 

分 类 号：R735.2[医药卫生—肿瘤]