改良SPLT食管-空肠吻合术在腹腔镜全胃切除术中的应用  

Application of modified SPLT esophagojejunostomy in laparoscopic total gastrectomy

作　　者：薛林强 戈军刚[1] 高林[1] 钱雷敏[1] 黄建明[1] Xue Linqiang;Ge Jungang;Gao Lin;Qian Leimin;Huang Jianming(Jiangyin Hospital affiliated to the School of Medicine of Southeast University,Jiangyin Jiangsu Province 214400,China)

机构地区：[1]东南大学医学院附属江阴医院,江苏江阴214400

出　　处：《中华普外科手术学杂志(电子版)》2025年第2期212-215,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探究改良自牵引后离断(SPLT)食管-空肠吻合术在腹腔镜全胃切除术(LTG)中的应用效果。方法回顾性分析2019年1月至2023年10月行LTG的180例胃癌患者的临床资料。按照术中食管-空肠吻合方式的不同将患者分为改良SPLT组和Roux-en-Y组,改良SPLT组120例患者采取改良SPLT食管-空肠吻合术,Roux-en-Y组60例患者采取传统的食管-空肠Roux-en-Y吻合。应用软件SPSS 22.0分析数据,手术相关指标、肠黏膜屏障功能指标等计量资料以(±s)表示,采用独立样本t检验;术后并发症等计数资料采用χ^(2)检验。以P<0.05为差异有统计学意义。结果改良SPLT组患者手术时间、吻合时间、术中出血量、肠鸣音恢复时间、术后VAS评分均明显低于Roux-en-Y组(P<0.05);两组患者术后住院时间及淋巴结清扫枚数相比差异无统计学意义(P>0.05)。改良SPLT组患者术后并发症的总发生率较Roux-en-Y组明显降低(5.8%vs.16.7%,P<0.05)。术后两组患者血清D-乳酸(D-LAC)、二胺氧化酶(DAO)及内毒素(ET)水平较术前均显著升高(P<0.05),但改良SPLT组3项指标明显低于Roux-en-Y组(P<0.05)。结论改良SPLT食管-空肠吻合术应用于LTG中,不仅可简化吻合过程,缩短手术时间,减少术中损伤,还可减轻患者术后疼痛,降低并发症的发生风险,且对肠黏膜的屏障功能影响更小,更利于胃肠功能的恢复,值得推广。Objective To investigate the effect of modified self-traction post-dissection(SPLT)esophagojejunostomy in laparoscopic total gastrectomy(LTG).Methods The clinical data of 180 patients with gastric cancer who received LTG from January 2019 to October 2023 were retrospectively analyzed.Patients were divided into modified SPLT group and Roux-en-Y group according to different intraoperative esophagojejunal anastomosis methods.In the modified SPLT group,120 patients underwent modified SPLT esophagojejunostomy,and in the Roux-en-Y group,60 patients underwent traditional esophagojejunostomy.SPSS 22.0 software was used to analyze the data.Surgical indicators,intestinal mucosal barrier function indicators and other measurement data were expressed as(x±s),and independent sample t test was used.The statistical data of postoperative complications were analyzed byχ^(2)test.P<0.05 was considered to be statistically significant.Results Operation time,anastomosis time,intraoperative blood loss,intestinal sound recovery time and postoperative VAS score in modified SPLT group were significantly lower than those in Roux-en-Y group(P<0.05).There was no significant difference in hospital stay and number of lymph nodes dissection between the two groups(P>0.05).The overall incidence of postoperative complications in the modified SPLT group was significantly lower than that in the Roux-en-Y group(5.8%vs.16.7%,P<0.05).The serum levels of D-lactate(D-LAC),diamine oxidase(DAO)and endotoxin(ET)in 2 groups were significantly increased after surgery(P<0.05),but the three indexes in modified SPLT group were significantly lower than those in Rouxen-Y group(P<0.05).Conclusion The application of modified SPLT esophagojejunostomy in LTG can not only simplify the anastomosis process,shorten the operation time and reduce the intraoperative injury,but also reduce the postoperative pain of patients and reduce the risk of complications.Besides,it has less impact on the intestinal mucosal barrier function and is more conducive to the recovery of gastr

关 键 词：胃肿瘤 腹腔镜 胃切除术 吻合术 ROUX-EN-Y 自牵引后离断 

分 类 号：R73[医药卫生—肿瘤]