不同吻合器在腹腔镜远端胃癌根治术Roux-en-Y式吻合中的应用对比  

Comparison of different staplers in Roux-en-Y anastomosis during laparoscopic radical gastrectomy for distal gastric cancer

作　　者：刘海旺 施海 尚利峰 Liu Haiwang;Shi Hai;Shang Lifeng(Xi'an Daxing Hospital,Xi'an Shaanxi Province 710000,China)

机构地区：[1]西安大兴医院,西安710000

出　　处：《中华普外科手术学杂志（电子版）》2024年第6期643-646,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：陕西省2023年科技计划项目(2023-JC-YB-786)。

摘　　要：目的对比不同吻合器在腹腔镜远端胃癌根治术Roux-en-Y式吻合中的应用效果。方法回顾性分析2020年10月至2023年10月行腹腔镜远端胃癌根治术Roux-en-Y式吻合的135例远端胃腺癌患者临床资料。根据术中残胃空肠吻合口重建时应用吻合器不同将患者分为A组(n=66例,圆型吻合器)和B组(n=69例,直线切割闭合器)。采用SPSS 27.0软件处理数据,手术情况、术后恢复情况、营养状况指标等计量资料以(χ±s)表示,采用独立样本t检验;术后近远期并发症等计数资料行χ^(2)检验或Fisher精确检验。P<0.05为差异具有统计学意义。结果两组患者手术时间、术中出血量、病灶距上切缘距离、病灶距下切缘距离、淋巴结清扫总数比较,差异无统计学意义(P>0.05);B组患者术后首次排气时间、首次进食流质饮食时间短于A组(P<0.05);与A组患者相比,B组术后6个月时吻合口狭窄发生率较低(P<0.05),其他近远期并发症发生率两组患者术后比较差异无统计学意义(P>0.05);术后6个月,两组患者血红蛋白、总蛋白及白蛋白水平均低于术前,但B组高于A组(P<0.05)。结论腹腔镜远端胃癌根治术Roux-en-Y式吻合中,应用圆型吻合器与直线切割闭合器均可行,但与圆型吻合器相比,直线切割闭合器可缩短患者术后排气时间及进流质饮食时间,降低术后远期吻合口狭窄率,改善患者术后远期营养状况。Objective To compare the application effect of different staplers in Roux-en-Y anastomosis during laparoscopic radical gastrectomy for distal gastric cancer.Methods The clinical data of 135 patients with distal gastric adenocarcinoma who underwent laparoscopic radical gastrectomy Roux-en-Y anastomosis from October 2020 to October 2023 were retrospectively analyzed.The patients were divided into group A(n=66 cases,circular stapler)and group B(n=69 cases,linear cutting and closing device)according to the different staplers used during reconstruction of residual gastrojejunal anastomosis.SPSS 27.0 software was used to process the data.The measurement data such as operation,postoperative recovery and nutritional status were expressed as(χ±s),and independent sample t test was used.The statistical data of postoperative complications in the near and long term wereχ^(2) test or Fisher exact test.P<0.05 was considered statistically significant.Results There was no significant difference in operation time,intraoperative blood loss,distance from lesion to upper incisal margin,distance from lesion to lower incisal margin,and total number of lymph nodes dissection between the two groups(P>0.05).The time of first postoperative exhaust and first intake of liquid diet in group B were shorter than those in group A(P<0.05).There was no statistical significance in the total incidence of postoperative complications between the two groups(P>0.05),but compared with group A,the incidence of anastomotic stenosis in group B was lower at 6 months after surgery(P<0.05).Six months after surgery,the levels of hemoglobin,total albumin and albumin in 2 groups were lower than before surgery,but those in group B were higher than those in group A(P<0.05).Conclusion In the Roux-en-Y anastomosis of laparoscopic radical gastrectomy for distal gastric cancer,both circular stapler and linear cutting and closing device are feasible.However,compared with circular stapler,linear cutting and closing device can shorten the postoperative exhaust time and

关 键 词：胃肿瘤 腹腔镜 胃切除术 吻合术 Roux-en-Y 

分 类 号：R735.2[医药卫生—肿瘤]