全腹腔镜下SiewertⅡ/Ⅲ型食管胃结合部腺癌根治术食管空肠手工吻合与器械吻合对比研究  

A comparative study of manual esophagojejunostomy versus instrumental anastomosis during total laparoscopic esophagogastrectomy for Siewert typeⅡ/Ⅲadenocarcinoma of esophagogastric junction

作　　者：赵文杰 姚磊[1] 谢华兵 王映捷 吴安定[3] 杜恒 Zhao Wenjie;Yao Lei;Xie Huabing;Wang Yingjie;Wu Anding;Du Heng(Department of Gastrointestinal Surgery,CR&WISCO General Hospital Affiliated to Wuhan University of Science&Technology,Hubei Wuhan 430000,China;School of Medicine,Wuhan University of Science&Technology,Hubei Wuhan 430000,China;Department of Gastrointestinal Surgery,Central Municipal Hospital,Hubei Huanggang 438000,China)

机构地区：[1]武汉科技大学附属华润武钢总医院,湖北武汉430080 [2]武汉科技大学医学部医学院,湖北武汉430081 [3]黄冈市中心医院胃肠外科,湖北黄冈438000

出　　处：《腹部外科》2024年第6期442-447,共6页Journal of Abdominal Surgery

基　　金：2023年湖南省人民医院医联体专项科研基金(2023YL010);2021年度湖北省卫生计生委科研项目(WJ2021M083)。

摘　　要：目的探讨在全腹腔镜下行SiewertⅡ/Ⅲ型食管胃结合部腺癌根治术中采用手工吻合与器械吻合的术中、术后结果差异。方法收集2021年1月至2023年12月期间在武汉科技大学附属华润武钢总医院接受全腹腔镜下SiewertⅡ/Ⅲ型食管胃结合部腺癌根治术的病人资料,根据吻合方式不同分为手工吻合组与器械吻合组。比较两组病人的总手术时间、食管空肠吻合时间、术中出血量、术后并发症发生情况、术后住院时间、住院总费用等指标。结果共纳入42例病人,其中手工吻合组22例、器械吻合组20例。手工吻合组与器械吻合组病人比较,食管空肠吻合时间[(25.82±2.79)min比(31.65±3.03)min,P<0.001]和总手术时间[(256.18±19.31)min比(269.65±17.14)min,P<0.05]均低,差异均有统计学意义。手工吻合组病人的平均住院总费用比器械吻合组低4560元,差异有统计学意义(P<0.001)。两组病人的术中出血量、术后首次通气时间和术后住院时间比较,差异均无统计学意义(均P>0.05)。两组病人的术后主要并发症发生率差异无统计学意义(22.7%比30.0%,P>0.05)。结论腹腔镜下食管空肠手工吻合是一种安全可靠、精准高效的手术方法,可作为器械吻合的重要补充,因其减少了额外的吻合器械及其相关耗材使用,在一定程度上节省了医保资金和病人的住院费用。Objective To explore the differences in intraoperative and postoperative outcomes between hand-sewn esophagojejunostomy and instrumental anastomosisin total laparoscopic esophagogastrectomy for SiewertⅡ/Ⅲadenocarcinoma of esophagogastric junction.Methods From January 2021 to December 2023,the relevant clinical data were retrospectively reviewed for 42 patients undergoing total laparoscopic radical resection of Siewert hagojejunostomy and instrumental anastomosis.They were assigned into two groups of manual(n=22)and instrument(n=20)anastomosis based upon different modes of anastomosis.Total operative duration,esophagojejunostomy time,intraoperative volume of blood loss,postoperative complications,length of hospitalization stay and total hospitalization expense were compared between two groups.Results Time of esophagojejunostomy[(25.82±2.79)min vs(31.65±3.03)min,P<0.001]and total operative duration[(256.18±19.31)min vs(269.65±17.14)min,P<0.05]were significantly lower in manual anastomosis group than those in instrument anastomosis group.The difference was statistically significant.Average total hospitalization cost of manual anastomosis group was 4,560 yuan lower than that of instrument anastomosis group and the difference was statistically significant(P<0.001).No significant inter-group differences existed in intraoperative volume of blood loss,initial postoperative ventilation time or postoperative hospitalization stay(all P>0.05).No significant inter-group difference existed in the incidence of major postoperative complications(22.7%vs 30.0%,P>0.05).Conclusion Laparoscopic manual esophagojejunostomy is a safe,reliable,accurate and efficient surgical procedure.It may serve as an important supplement to instrument anastomosis since it reduces the use of additional anastomotic instruments and saves medical insurance funds and hospitalization expenses.

关 键 词：食管胃结合部腺癌 手工吻合 器械吻合 食管空肠吻合 全腹腔镜 

分 类 号：R656.6[医药卫生—外科学]