摘要
目的 比较全腹腔镜下全胃切除术中食管空肠改良π形吻合术与食管空肠端侧吻合术两种术式的临床效果和安全性.方法 回顾性分析2020年3月至2023年2月在江苏省肿瘤医院择期行完全腹腔镜根治性全胃切除术的100例胃腺癌患者资料.根据术式不同分为改良π形吻合组与端侧吻合组,每组各50例,分别在全腹腔镜全胃切除术中选择食管空肠改良π形吻合术与食管空肠端侧吻合术.比较两组患者的手术指标(手术出血量、手术时间、切口长度以及吻合时间)、术后康复指标(术后排气时间、术后首次进食以及引流管撤除时间、住院时间)、疼痛指标[术后6 h、术后1 d、术后3 d视觉模拟评分法(VAS)]、病理分期(TNM分期)以及围手术期并发症(肺部感染、吻合口狭窄、切口感染、胃食管反流)发生情况.结果 两组患者的手术出血量和手术时间比较,差异均无统计学意义(P＞0.05);改良π形吻合组患者的切口长度和吻合时间分别为(5.29±1.48)cm、(31.44±7.96)min,均明显短于端侧吻合组[(11.06±1.33)cm、(43.86±6.51)min],差异均有统计学意义(P＜0.05).两组患者的术后排气时间、术后首次进食时间、引流管拔管时间、住院时间比较,差异均无统计学意义(P＞0.05).术后6 h,两组患者的疼痛VAS评分比较,差异无统计学意义(P＞0.05);术后1 d、术后3 d,改良π形吻合组患者的疼痛VAS评分分别为(5.02±0.71)、(3.08±0.87)分,均明显低于端侧吻合组[(5.97±0.89)、(5.94±1.04)分],差异均有统计学意义(P＜0.05).两组术后病理分期均相比术前明显改善,组内比较差异有统计学意义(P＜0.05);两组患者的术前、术后病理分期组间比较,差异均无统计学意义(P＞0.05).两组患者术后并发症发生率比较,差异无统计学意义(P＞0.05).结论 全腹腔镜全胃切除术中选择食管空肠改良π形吻合术的临床预后良好,相比端侧吻合术的术源性创伤更小,手术时间更短,对于患者术后疼痛控制有更好的效果,术后并发症发生率也未发现明显升高,值得临床推广应用.
Abstract
Objective To compare the clinical effect and safety of modified esophagojejunostomy π-shaped anastomosis and end-jeju-nal anastomosis during total laparoscopic gastrectomy.Methods A retrospective analysis of the patient data of 100 patients with gastric adenocar-cinoma who underwent elective total laparoscopic radical gastrectomy at Jiangsu Cancer Hospital from March 2020 to February 2023 was performed.According to different surgical methods,the patients were divided into two groups:the modified π-shaped anastomosis group and the end to side anastomosis group,with 50 cases in each group.In total laparoscopic gastrectomy,the modified π-shaped anastomosis of the esophagus and je-junum and the end to side anastomosis of the esophagus and jejunum were selected,respectively.The surgical parameters(blood loss,operation time,incision size,and anastomosis operation time),postoperative rehabilitation parameters(postoperative exhaust time,time of first feeding after surgery,drainage tube removal time,and hospital stay),pain parameters[the visual analogue scale(VAS)of 6 h,1 d,and 3 d after surgery],pathological stage(TNM stage),and perioperative complications(pulmonary infection,anastomotic stenosis,incision infection,and gastroesopha-geal reflux)were compared between the two groups.Results There were no statistically significant differences in the amount of surgical bleeding and surgical time between the two groups of patients(P＞0.05);the incision length and anastomosis time of patients in the modified π-shaped anastomosis group were(5.29±1.48)cm and(31.44±7.96)min,respectively,which were significantly shorter than those in the end to side anastomosis group[(11.06±1.33)cm and(43.86±6.51)min],and the differences were statistically significant(P＜0.05).There were no statistically significant differences in the postoperative exhaust time,time of first feeding after surgery,drainage tube removal time,and hospital stay between the two groups of patients(P＞0.05).After 6 h of surgery,there was no statistically significant difference in pain VAS scores be-tween the two groups of patients(P＞0.05);1 d and 3 d after surgery,the pain VAS scores of patients in the modified π-shaped anastomosis group were(5.02±0.71)and(3.08±0.87)points,respectively,which were significantly lower than those in the end to side anastomosis group[(5.97±0.89)and(5.94±1.04)points],and the differences were statistically significant(P＜0.05).The postoperative pathological staging of both groups showed significant improvement compared to preoperative,and there was a statistically significant difference within the group(P＜0.05);there were no statistically significant differences in preoperative and postoperative pathological staging between the two groups of patients(P＞0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups of patients(P＞0.05).Conclusion Total laparoscopic esophageal jejunum modified esophagojejunostomy π-shaped anastomosis has good clinical prognosis.Compared with end-side anastomosis,it has less surgical trauma and shorter operation time,which has better effect on postoperative pain control of patients.The incidence of postoperative complications is not significantly increased,which is worthy of clinical promotion and application.
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