中点优先缝合法应用于腹腔镜远端胃癌根治术消化道吻合的临床价值  

Clinical value of the midpoint‑priority suture in digestive tract anastomosis in laparoscopic distal gastrectomy of gastric cancer

作　　者：林和新 朱靖涛 洪清琦[1] 余荒岛 李永文[1] 陈逸南 陈东汉[1] 王海滨 陈毅福 肖亮斌 徐志文 尤俊[1] Lin Hexin;Zhu Jingtao;Hong Qingqi;Yu Huangdao;Li Yongwen;Chen Yinan;Chen Donghan;Wang Haibin;Chen Yifu;Xiao Liangbin;Xu Zhiwen;You Jun(Department of Gastrointestinal Oncology Surgery,the First Affiliated Hospital of Xiamen University,Xiamen 361003,China;School of Clinical Medicine,Fujian Medical University,Fuzhou 350108,China)

机构地区：[1]厦门大学附属第一医院胃肠肿瘤外科,厦门361003 [2]福建医科大学临床医学院,福州350108

出　　处：《中华消化外科杂志》2024年第3期406-413,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82303020);福建省自然科学基金(2021J011360);厦门市自然科学基金(3502Z20214ZD1018);福建省卫生健康委员会医疗创新项目(2021CXB019)。

摘　　要：目的探讨中点优先缝合法应用于腹腔镜远端胃癌根治术消化道吻合的临床价值。方法采用回顾性队列研究方法。收集2019年1月至2022年6月厦门大学附属第一医院收治的72例胃癌患者的临床病理资料;男52例,女20例;年龄为(56±11)岁。72例患者均行完全腹腔镜远端胃癌根治术(TLDG),其中2019年1―12月收治的50例患者消化道吻合采用侧边优先缝合法,设为侧边组;2021年6月至2022年6月收治的22例患者消化道吻合采用中点优先缝合法,设为中点组。观察指标:(1)手术情况。(2)并发症情况。(3)随访情况。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(范围)表示,组间比较采用Mann⁃Whitney U检验。计数资料以绝对数或百分比表示,组间比较采用χ²检验或Fisher确切概率法。等级资料比较采用秩和检验。结果(1)手术情况。72例患者顺利施行TLDG,无中转开腹患者。中点组和侧边组患者术后首次进食流质饮食时间比较,差异有统计学意义(t=-2.592,P<0.05)。(2)并发症情况。中点组和侧边组患者术后发生近期并发症分别为5例和20例,两组比较,差异无统计学意义(P>0.05)。两组患者术后并发症Clavien⁃Dindo评分、吻合口并发症比较,差异均无统计学意义(P>0.05)。所有患者并发症经治疗后痊愈出院。(3)随访情况。中点组患者中,19例获得随访(其中11例获得胃镜随访),随访时间为20(1~24)个月。侧边组患者中,49例获得随访(其中28例获得胃镜随访),随访时间为18(2~25)个月。两组患者复发转移、远期并发症、术后胆汁反流、残胃炎、食物潴留比较,差异均无统计学意义(P>0.05)。结论中点优先缝合法可应用于腹腔镜远端胃癌根治术消化道吻合。Objective To investigate the clinical value of midpoint-priority suture(MPS)in digestive tract anastomosis in laparoscopic distal gastrectomy of gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 72 patients with gastric cancer who were admitted to the First Affiliated Hospital of Xiamen University from January 2019 to June 2022 were collected.There were 52 males and 20 females,aged(56±11)years.All 72 patients underwent totally laparoscopic distal gastrectomy(TLDG),in which 50 patients being admitted from January to December 2019 and treated with the side-priority suture(SPS)method for digestive tract reconstruction were divided into the SPS group,and 22 patients being admitted from June 2021 to June 2022 and treated with MPS method for digestive tract reconstruction were divided into the MPS group,respectively.Observation indicators:(1)surgical conditions;(2)complications;(3)follow-up.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was conducted using the MannWhitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Comparison of ordinal data was conducted using the sum test.Results(1)Surgical conditions.All 72 patients underwent TLDG successfully,without conversion to open surgery.There was a significant difference in the time to postoperative first intake of liquid diet between the two groups(t=−2.592,P<0.05).(2)Complications.Cases with postoperative short-term complications in the MPS group and the SPS group were 5 and 20,respectively,showing no significant difference between the two groups(P>0.05).There was no significant difference in the Clavien-Dindo score of postoperative complications and anastomotic complications between the two groups(P

关 键 词：胃肿瘤 连续性手工缝合 消化道重建 完全腹腔镜远端胃癌根治术 应用 

分 类 号：R735.2[医药卫生—肿瘤]