Overlap吻合与π吻合在全腹腔镜全胃切除术中的应用  

Application of Overlap anastomosis and π anastomosis in totally laparoscopic total gastrectomy

作　　者：李锋[1] 彭德伟[1] 李文艺[1] 何静[1] 黄金向[1] LI Feng;PENG Dewei;LI Wenyi;HE Jing;HUANG Jinxiang(Department of General Surgery,Chengdu Fifth People′s Hospital,Chengdu 611130)

机构地区：[1]成都市第五人民医院普外科,成都611130

出　　处：《郑州大学学报（医学版）》2024年第4期531-536,共6页Journal of Zhengzhou University(Medical Sciences)

基　　金：四川省医学会伤口疾病(泰阁)专项科研课题(2021TG38)。

摘　　要：目的:比较Overlap吻合与π吻合在全腹腔镜全胃切除术(TLTG)中的应用效果。方法:选择2019年2月至2022年2月在成都市第五人民医院行TLTG的胃癌患者98例,根据食管空肠吻合方式分为Overlap吻合组(n=56)和π吻合组(n=42)。比较两组围手术期指标(手术时间、吻合时间、术中出血量、淋巴结清扫数目、术后肛门排气时间、术后拔除引流管时间、术后住院时间、肿瘤上缘至食管切缘距离),吻合口相关并发症(吻合口出血、吻合口狭窄、吻合口漏)与随访并发症(吻合口溃疡、倾倒综合征、反流性食管炎、营养不良)发生情况,以及术前与术后3个月整体营养状况主观评估量表(PG-SGA)评分与营养状况客观指标(血红蛋白、白蛋白、总蛋白)水平的变化。结果:Overlap吻合组手术时间[(230.36±25.12)min vs(205.58±20.43)min]、吻合时间[(43.22±6.15)min vs(27.45±5.36)min]均长于π吻合组(P<0.05);两组吻合口相关并发症、随访并发症发生率及术前、术后3个月PG-SGA量表评分与营养状况客观指标水平的变化差异均无统计学意义(P>0.05)。结论:Overlap吻合和π吻合在TLTG术中各有优势,π吻合可缩短手术时间和吻合时间。Aim:To compare the efficacy of Overlap anastomosis andπanastomosis in totally laparoscopic total gastrectomy(TLTG).Methods:Totally 98 patients with gastric cancer receiving TLTG between February 2019 and February 2022 were retrospectively analyzed.According to esophagojejunal anastomosis methods,the patients were allocated into Overlap anastomosis group(n=56)andπanastomosis group(n=42).The perioperative indicators(surgical time,anastomosis time,intraoperative blood loss,number of lymph node dissection,postoperative anal exhaust time,postoperative drainage tube removal time,postoperative hospital stay,distance from the upper tumor margin to the esophagotomy margin),anastomotic-related complications(anastomotic bleeding,anastomotic stenosis and anastomotic leakage)and follow-up complications(anastomotic ulcer,dumping syndrome,reflux esophagitis,malnutrition),as well as the difference values of Patient-Generated Subjective Global Assessment(PG-SGA)scores and objective indicators of nutritional status(hemoglobin,albumin,total protein)before surgery and at 3 months after surgery were compared between the 2 groups.Results:The surgical time and anastomosis time in Overlap group were longer than those inπanastomosis group[(230.36±25.12)min vs(205.58±20.43)min,(43.22±6.15)min vs(27.45±5.36)min,P<0.05].There were no statistical differences in the incidence rates of anastomotic-related complications or follow-up complications,the difference values of scores of PG-SGA,or the levels of objective indicators of nutritional status before surgery and at 3 months after surgery(P>0.05).Conclusion:Overlap anastomosis andπanastomosis have their respective advantages during TLTG,whileπanastomosis can shorten the surgical time and anastomosis time.

关 键 词：胃癌 全腹腔镜全胃切除术 Overlap吻合 π吻合 并发症 营养状况 

分 类 号：R734.2[医药卫生—肿瘤]