逆蠕动非离断Roux-en-Y吻合在腹腔镜远端胃癌根治术中的应用  

Application of antiperistaltic uncut Roux-en-Y anastomosis in laparoscopic distal gastrectomy for gastric cancer

作　　者：柯彬 金鹏 刘洪敏 王学军 刘宁 梁寒 张汝鹏 Ke Bin;Jin Peng;Liu Hongmin;Wang Xuejun;Liu Ning;Liang Han;Zhang Rupeng(Department of Gastric Cancer,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin Clinical Research Center for Cancer,Tianjin Key Laboratory of Digestive Cancer,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院胃部肿瘤科、国家恶性肿瘤临床医学研究中心、天津市恶性肿瘤临床医学研究中心、天津市消化系统肿瘤重点实验室,天津300060

出　　处：《中华普通外科杂志》2024年第10期764-769,共6页Chinese Journal of General Surgery

基　　金：国家自然科学基金(81401952);天津市卫生局科技基金(2014KZ082);天津市医学重点学科(专科)建设项目(TJYXZDXK-009A)。

摘　　要：目的探讨逆蠕动非离断Roux-en-Y吻合(Uncut RY)在腹腔镜远端切除术后消化道重建中的效果。方法收集2020年1月至2021年12月间天津医科大学肿瘤医院收治的309例行腹腔镜远端胃癌根治术患者的临床病理资料,根据重建方式不同将患者分为Uncut RY组(102例)、RY组(96例)、BⅡ+Braun组(111例),比较3组的手术安全性和近期、远期疗效。结果Uncut RY组和BⅡ+Braun组的手术时间较RY组明显缩短,差异有统计学意义(F=3.356,P=0.036)。3组患者的短期并发症差异无统计学意义(P>0.05)。BⅡ+Braun组反流性胃炎发生率高于Uncut RY组和RY组,差异有统计学意义(19.8%比6.9%比5.2%,F=13.889,P=0.001)。而RY组潴留综合征发生率高于Uncut RY组和BⅡ+Braun组,差异有统计学意义(15.6%比2.0%比2.7%,F=19.320,P=0.000)。3组患者术后1年的营养学变化率差异无统计学意义(P>0.05)。结论腹腔镜远端胃癌根治术中采用逆蠕动Uncut RY吻合安全可靠,能降低反流性胃炎及潴留综合征等并发症的发生率。Objective To investigate the clinical efficacy of antiperistaltic uncut Roux-en-Y anastomosis(Uncut RY)in laparoscopic distal gastrectomy(LDG)for gastric cancer(GC).Methods The clinicpathological data of 309 patients who underwent LDG for GC between Jan 2020 to Dec 2021 in Tianjin Medical University Cancer Institute&Hospital were collected.Among them,102 cases received antiperistaltic Uncut RY anastomosis,96 cases did RY anastomosis,and 111 cases did BⅡ+Braun anastomosis.The general data and clinical efficacy were compared.Results The operative time in Uncut RY group and BⅡ+Braun group was shorter than that in RY group(F=3.356,P=0.036).The incidence of postoperative short-term complications was not statistically different among three groups(P>0.05).Compared to Uncut RY group and RY group,the BⅡ+Braun group had a significantly higher incidences of reflux gastritis(19.8%vs.6.9%vs.5.2%,F=13.889,P=0.001).The incidence of RY stasis syndrome in RY group(15.6%)was significantly higher than that in Uncut RY group(2.0%)and BⅡ+Braun group(2.7%)(F=19.320,P=0.000).There were no significant differences in postoperative 1-year nutritional indexes among three group(P>0.05).Conclusions The antiperistaltic Uncut RY anastomosis in LDG for GC is safe and feasible,which can reduce the incidences of reflux gastritis and RY stasis syndrome.

关 键 词：胃肿瘤 吻合术 ROUX-EN-Y 蠕动 胃切除术 腹腔镜 

分 类 号：R735.2[医药卫生—肿瘤]