反穿刺、Overlap与π式食管空肠吻合在腹腔镜全胃切除术后消化道重建中的应用比较  

Comparative application of esophagojejunostomy with reverse puncture technique,overlap,andπ-shaped anastomosis in the reconstruction after laparoscopic total gastrectomy

作　　者：王金榜 冯伟宇 徐冬利 程科 刘永刚 李保东 庄競 WANG Jinbang;FENG Weiyu;XU Dongli(Department of General Surgery,the Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital,Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)普外科,河南郑州450008

出　　处：《腹腔镜外科杂志》2025年第1期17-22,共6页Journal of Laparoscopic Surgery

摘　　要：目的:探讨完全腹腔镜下采用不同食管-空肠吻合方法治疗进展期胃癌的安全性与可行性。方法:回顾分析2019年6月至2022年12月行全胃切除术的123例进展期贲门胃体癌患者的临床资料,依据吻合方式分为反穿刺组(n=59)、Overlap组(n=31)与π式组(n=33)。结果:三组患者年龄、性别、切口长度、术中出血量、排气时间、住院时间、清扫淋巴结数量、肿瘤直径差异无统计学意义。反穿刺组中SiewertⅡ型患者占比更高,与另外两组相比差异有统计学意义。反穿刺组与Overlap组手术时间差异无统计学意义,π式组手术时间短于另外两组,差异有统计学意义。结论:全腹腔镜下应用食管空肠反穿刺法、Overlap法与π式吻合均是安全、可行的。反穿刺法可完成更高位的食管空肠吻合,π式吻合在操作难度、食管切除距离方面具有明显优势。Objective:To explore the safety and feasibility of laparoscopic esophagojejunostomy with reverse puncture technique,Overlap andπ-shaped anastomosis in the reconstruction of digestive tract after radical total gastrectomy.Methods:A retrospective analysis was conducted on clinical data of 123 patients who underwent laparoscopic esophagojejunostomy for locally advanced gastric cancer from Jun.2019 to Dec.2022.According to the anastomosis method,they were divided into three groups:reverse puncture group(n=59),overlap group(n=31),andπ-shaped group(n=33).Results:There was no statistically significant difference in age,gender,incision length,blood loss,exhaust time,hospital stay,retrieved lymph nodes,and tumor size among the three groups.There were more Siewert typeⅡpatients in the reverse puncture group than in the Overlap andπ-shaped group(P<0.05).The operative time in the reverse puncture group was comparative to the overlap group(P>0.05).The operative time in theπ-shaped group was significantly shorter than that in the reverse puncture and overlap group(P<0.05).Conclusions:Totally laparoscopic reverse puncture,Overlap,andπ-shaped anastomosis are all safe and feasible in selected patients.The reverse puncture method can complete higher-level esophagojejunostomy,while theπ-shaped method has obvious advantages in terms of operational difficulty and the extent of esophageal resection.

关 键 词：胃肿瘤 全胃切除术 腹腔镜检查 食管空肠吻合 疗效比较研究 

分 类 号：R735.2[医药卫生—肿瘤]