空肠后离断Overlap吻合法在腹腔镜根治性全胃切除术中的应用  

Application of jejunum-later-cut Overlap method for esophagojejunostomy during totally laparoscopic total gastrectomy

作　　者：徐李嘉 沈晓军 Xu Lijia;Shen Xiaojun(Gusu College,Nanjing Medical University,Jiangsu Kunshan 215300;First Municipal People’s Hospital,Jiangsu Kunshan 215300)

机构地区：[1]南京医科大学姑苏学院,江苏昆山215300 [2]昆山市第一人民医院普外科,江苏昆山215300

出　　处：《腹部外科》2024年第2期106-110,共5页Journal of Abdominal Surgery

基　　金：昆山市级科技专项立项项目(KSF202128)。

摘　　要：目的探讨空肠后离断Overlap吻合法相比传统Overlap吻合法在腹腔镜根治性全胃切除术中的优势及安全性。方法回顾分析2018年3月至2023年6月在昆山市第一人民医院行腹腔镜根治性全胃切除术的胃癌病人资料共43例,根据食管空肠吻合方式的不同进行分组。研究组25例,采用空肠后离断Overlap吻合法进行食管空肠重建;对照组18例,采用传统Overlap吻合法。比较两组病人在围手术期及术后近期指标等方面有无差异。结果两组病人的一般资料比较,差异均无统计学意义(均P>0.05)。两组病人均顺利完成手术,无中转开腹病例。在饮食随访中,研究组病人术后1个月均已恢复半流质饮食或普食,术后3个月均能进食普食。两组病人的术中出血量、术后住院时间以及吻合口漏、吻合口狭窄、吻合口出血等吻合口并发症的发生率相比较,差异均无统计学意义(均P>0.05)。同对照组相比较,研究组的食管空肠吻合时间[(25.4±4.3)min比(39.8±4.5)min,t=–10.549,P<0.001]和手术时间[237 min(230~250 min)比258.6 min(250~285 min),Z=–5.517,P<0.001]均缩短,差异具有统计学意义(均P<0.001)。结论在腹腔镜根治性全胃切除的病人中,改良后的空肠后离断Overlap吻合较传统Overlap吻合更加简便,是一种较好的、安全可行的吻合方式。Objective To explore the advantages and safety of jejunum-later-cut Overlap method versus traditional Overlap method during totally laparoscopic total gastrectomy(TLTG).Methods From March 2018 to June 2023,the relevant clinical data were retrospectively reviewed for 43 patients underwent TLTG at First Municipal People's Hospital.According to different esophagojejunal anastomosis modes,they were assigned into two groups of jejunum-later-cut Overlap(n=25)and traditional overlap(n=18).The perioperative and postoperative short-term parameters were compared between two groups.Results No statistically significant inter-group differences existed in general profiles(all P>0.05).All operations were completed successfully without any conversion into open surgery.During follow-ups,jejunum-later-cut overlap group resumed a semi-liquid or normal diet at Month 1 post-operation and started a normal diet at Month 3 post-operation.No significant differences existed in intraoperative volume of blood loss,postoperative hospitalization stay or the incidence of such anastomotic complications as eakage,stenosis or hemorrhage(all P>0.05).As compared with traditional Overlap group,durations of esophagojejunostomy[(25.4±4.3)vs(39.8±4.5)min,t=–10.549,P<0.001]and operative duration[237(230–250)vs 258.6(250-285)min,Z=–5.517,P<0.001]were significantly shorter in jejunum-later-cut overlap group than those in traditional overlap group and the differences were statistically significant(all P<0.001).Conclusion In patients undergoing TLTG,jejunum-later-cut Overlap method is more convenient than traditional Overlap method and anastomosis is better,safe and feasible.

关 键 词：全腹腔镜全胃切除术 胃癌 Overlap吻合 

分 类 号：R656.6[医药卫生—外科学]