加速康复外科路径下腹腔镜全胃切除术后完全腹腔镜食管-空肠π吻合的临床疗效  

Clinical efficacy of totally laparoscopicπ-shaped esophagojejunostomy following laparoscopic gastrectomy under the enhanced recovery after surgery pathway

作　　者：郭建 孙康[1] 瞿建国[1] 陈吉祥[1] 范昕[1] 谢嵘[1] 党胜春[1] 金玺 GUO Jian;SUN Kang;QU Jianguo;CHEN Jixiang;FAN Xin;XIE Rong;DANG Shengchun;JIN Xi(Department of Gastrointestinal Surgery,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212001,China)

机构地区：[1]江苏大学附属医院胃肠外科,江苏镇江212001

出　　处：《中国普通外科杂志》2022年第8期1080-1088,共9页China Journal of General Surgery

基　　金：江苏省镇江市重点研发计划(社会发展)资助项目(SH2018082,SH2019089)。

摘　　要：背景与目的:完全腹腔镜下全胃切除食管-空肠π吻合是一种新的腹腔镜下全胃切除术后全消化道重建方式,该方法与传统腹腔镜辅助食管-空肠Roux-en-Y吻合术在传统临床路径下的比较已有较多研究,但在加速康复外科(ERAS)路径下两者临床效果比较的研究较少,本研究比较ERAS路径中腹腔镜全胃切除术后全腹腔镜食管-空肠π吻合术与腹腔镜辅助下Roux-en-Y吻合的临床效果。方法:回顾性分析江苏大学附属医院2017年6月—2019年12月65例行胃癌手术的患者临床资料,所有患者进入ERAS路径,均行腹腔镜全胃切除术,其中30例消化道重建采用完全腹腔镜食管-空肠π吻合术(π吻合组),35例消化道重建采用传统腹腔镜辅助下食管-空肠Roux-en-Y吻合术(Roux-en-Y吻合组),比较两组患者的术中、术后及随访的相关指标。结果:两组患者术前资料具有可比性。π吻合组在切口长度、术后首次下床时间、肛门首次排气时间、进食时间、术后疼痛及住院时间方面均优于Roux-en-Y吻合组(均P<0.05);手术时间、术中出血量、淋巴结清扫总数、住院总费用以及术后并发症,两组比较差异均无统计学意义(均P>0.05);在术后随访中,π吻合组4例、Roux-en-Y吻合组6例发生不同程度的转移与复发,差异无统计学意义(P>0.05);π吻合组患者的1年生存率为73.33%,Roux-en-Y吻合组为77.14%,差异无统计学意义(P>0.05)。结论:腹腔镜全胃切除术后,采用完全腹腔镜全胃切除食管-空肠π吻合手术具有创伤小,恢复快,患者住院时间短等优点,在ERAS路径中更有利于其优势的发挥。Background and Aims:Totally laparoscopicπ-shaped esophagojejunostomy is a new digestive tract reconstruction method after laparoscopic total gastrectomy.There are a number of studies comparing this method with the conventional laparoscopic-assisted Roux-en-Y esophagojejunostomy under the traditional clinical pathway,but few reports comparing the two methods under the clinical pathway of enhanced recovery after surgery(ERAS).Therefore,this study was conducted to compare the clinical effects of totally laparoscopicπ-shaped esophagojejunostomy and laparoscopic-assisted Roux-en-Y esophagojejunostomy following laparoscopic total gastrectomy in ERAS pathway.Methods:The clinical data of 65 patients undergoing surgery for gastric cancer from June 2017 to December 2019 were analyzed retrospectively.All patients entered the ERAS pathway and underwent laparoscopic total gastrectomy.Of them,totally laparoscopicπ-shaped esophagojejunostomy was used to reconstruct the digestive tract in 30 cases(π-shaped anastomosis group)and laparoscopic-assisted Rouxen-Y esophagojejunostomy was used to restore the digestive tract in 35 cases(Roux-en-Y anastomosis group).The intra-and postoperative variables and follow-up data were compared between the two groups.Results:The preoperative date of the two groups were comparable.The incision length,the time to first postoperative ambulation,time to first anal gas passage,time to first food intake,postoperative pain and length of hospitalization inπ-shaped anastomosis group were superior to those in anastomosis Roux-en-Y group(all P<0.05).There were no significant differences in operative time,intraoperative blood loss,total number of lymph node dissection,total hospitalization cost and overall incidence of postoperative complications between the two groups(all P>0.05).During postoperative follow-up,different degrees of metastasis and recurrence occurred in 4 patients inπ-shaped anastomosis group and 6 patients in Rouxen-Y anastomosis group,and the difference had no statistical significance

关 键 词：胃肿瘤 胃切除术 腹腔镜 π吻合 ROUX-EN-Y吻合 加速康复外科 

分 类 号：R735.2[医药卫生—肿瘤]