作者：张凯，王俊峰，王飞，茆家定

单位：皖南医学院第一附属医院弋矶山医院 胃肠二科，安徽 芜湖241001

Authors:  ZHANG Kai, WANG Junfeng, WANG Fei, MAO Jiading

Unit: No.2 Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, Anhui, China

摘要：

目的  比较食管空肠π型吻合与辅助切口Roux-en-Y吻合在腹腔镜全胃切除术中的临床疗效,探讨π型吻合技术在完全腹腔镜全胃切除术中的安全性及可行性。方法  收集分析我院2016年12月～2017年12月的40例全胃切除术中实施完全腔镜下食管空肠π型吻合的患者(π组)和45例接受辅助切口Roux-en-Y吻合的患者(Roux-en-Y组)的临床资料,然后对比分析两组患者的术中指标以及术后指标,借此来评判两组的治疗效益。结果  85例全胃切除手术均顺利完成手术。π组的切口长度、饮食流质时间、下床活动及住院时间及术后疼痛评分均优于Roux-en-Y组(P<0.05)。两组的术中出血量、吻合完成时间、清除的淋巴结总量以及总费用对比无明显差别(P>0.05)。Roux-en-Y组术后并发症发生率15.6%(7/45),π组术后并发症发生率5%(2/40),两组对比无统计学差异(P>0.05)。结论  食管空肠π型吻合在腔镜全胃切除术中应用安全可靠且近期效益满意,与传统Roux-en-Y吻合相比具有痊愈快、住院天数少、腹壁创伤小,术后疼痛轻等优势,初步观察结果是一种值得推广的吻合手段。

关键词： 腹腔镜; 全胃切除; π型吻合; Roux-en-Y吻合; 临床疗效

Abstract：

Objective  To compare the clinical effect of π-Shaped esophagojejunostomy and auxiliary incision Roux-en-Y anastomosis in laparoscopic total gastrectomy, and to explore the safety and feasibility of π-Shaped anastomosis in complete laparoscopic total gastrectomy. Methods  From December 2016 to December 2017, 40 patients underwent complete laparoscopic π-Shaped esophagojejunostomy (π group) and 45 patients who underwent an auxiliary incision Roux-en-Y anastomosis (Roux-en-Y group). Then compare the intraoperative and postoperative indexes of the two groups to evaluate the therapeutic effects of the two groups. Results  All procedures were completed successfully. The incision length, the time to fluid diet, the off-bed time and the hospital stay, and postoperative pain scores in the πgroup were superior to those in the Roux-en-Y group (P<0.05). However, there were no significant difference in intraoperative blood loss, the time of anastomosis, the number of cleared lymph nodes, and total cost between the two groups (P>0.05). The incidence of postoperative complications was 15.6% (7/45) in the Roux-en-Y group and 5% (2/40) in the π group. There was no significant difference between the two groups (p>0.05). Conclusion  π-Shaped esophagojejunostomy is safe and reliable in complete laparoscopic total gastrectomy, and the short-term benefits are satisfactory. Compared with traditional Roux-en-Y anastomosis, it has the advantages of quick recovery, less hospitalization, less abdominal wall trauma and light postoperative pain. Preliminary observation show that π-Shaped is an anastomotic means worth promoting.

Key Words:  Laparoscopy; Total gastrectomy; π-Shaped anastomosis; Roux-en-Y anastomosis; Clinical effect