腹腔镜远端胃癌根治术中不同吻合方式的应用对比  

Comparison of the Application of Different Anastomosis Methods in Laparoscopic Radical Gastrectomy for Distal Gastric Cancer

作　　者：黄向上 焦光辉 李永强 林功攀 HUANG Xiangshang;JIAO Guanghui;LI Yongqiang(General Hospital of Pingmei Shenma Group,Pingdingshan,467000)

机构地区：[1]平煤神马医疗集团总医院,467000

出　　处：《实用癌症杂志》2025年第3期463-466,483,共5页The Practical Journal of Cancer

摘　　要：目的 探讨在腹腔镜远端胃癌根治术中应用不同方式吻合的临床效果。方法 采用前瞻性随机对照研究,纳入拟行腹腔镜远端胃癌根治术治疗的64例患者,依据随机数字表法分为A组(32例,U-RY吻合术)和B组(32例,改良BillrothⅡ+Brown吻合术)。比较2组患者围术期指标、术前和术后肿瘤标志物[癌胚抗原(CEA)、糖类抗原19-9(CA19-9)]水平、胃肠道功能[胃肠道症状评定量表(GSRS)]、生活质量[卡氏功能状态评分(KPS)]以及术后并发症发生情况。结果 A组术中出血量少于B组,首次排气时间、手术时间、住院时间短于B组(P<0.05)。术后3个月和术后6个月时,2组血清CA19-9、CEA水平均低于术前(P<0.05),但组间差异无统计学意义(P>0.05)。术后3个月和术后6个月时,A组GSRS评分高于B组(P<0.05)。术后6个月时,A组KPS评分低于B组(P<0.05)。A组术后并发症总发生率高于B组(P<0.05)。结论 U-RY吻合术和改良BillrothⅡ+Brown吻合术应用于腹腔镜远端胃癌根治术中,均可降低肿瘤标志物水平,但相较于后者,前者术中出血量较少,住院时间、首次排气时间、手术时间较短,但术后并发症发生率较高,而后者在改善患者胃肠道功能和提高患者生活质量方面效果更好,临床可根据实际情况选择合理的吻合方式。Objective To explore the clinical effect of different anastomosis methods in laparoscopic radical gastrectomy for distal gastric cancer.Methods A prospective randomized controlled study was conducted.64 patients underwent laparoscopic radical gastrectomy for distal gastric cancer were included.According to the random number table method,they were divided into group A(32 cases,U-RY anastomosis)and group B(32 cases,modified BillrothⅡ+Brown anastomosis),32 cases in each group.Perioperative indicators,preoperative and postoperative tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9)]levels,gastrointestinal function[gastrointestinal symptom rating scale(GSRS)],quality of life[Karnofsky performance status score(KPS)],and postoperative complications were compared between the 2 groups.Results Group A had less intraoperative bleeding than Group B,and had shorter first exhaust time,surgery time,and hospital stay compared to Group B(P<0.05).At 3 months and 6 months after surgery,the serum levels of CA19-9 and CEA in both groups were lower than before surgery(P<0.05).But there was no statistical significant difference between the groups(P>0.05).At 3 months and 6 months after surgery,Group A had a higher GSRS score than Group B(P<0.05).At 6 months post surgery,the KPS score of Group A was lower than that of Group B(P<0.05).The total incidence of postoperative complications in Group A was higher than that in Group B(P<0.05).Conclusion U-RY anastomosis and modified BillrothⅡ+Brown anastomosis in laparoscopic radical gastrectomy for distal gastric cancer can decrease tumor markers level,and compared with the latter,the former has less intraoperative blood loss,shorter hospitalization time,first exhaust time and operation time,but higher postoperative complications,while the latter has better effect in improving patients'gastrointestinal function and improving patients'quality of life.Reasonable anastomosis can be selected according to the actual situation.

关 键 词：腹腔镜远端胃癌根治术 U-RY吻合术 改良BillrothⅡ+Brown吻合术 

分 类 号：R735.2[医药卫生—肿瘤]