中国实用外科杂志

中国实用外科杂志

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全腹腔镜远端胃癌根治术非离断式Roux-en-Y吻合与传统吻合疗效对照多中心研究

冯兴宇1，杨    力2，朱甲明3，臧卫东4，王    宽5，尤    俊6，臧    璐7，王    伟8，李子禹9，樊林10，李    勇1   

  1. 1广东省人民医院 广东省医学科学院，广东广州510080；2南京医科大学第一附属医院，江苏南京210029；3吉林大学第二医院，吉林长春130041；4福建省肿瘤医院，福建福州350014；5哈尔滨医科大学附属肿瘤医院，黑龙江哈尔滨150081；6厦门大学附属第一医院，福建厦门361003；7上海交通大学医学院附属瑞金医院，上海200025；8广东省中医院，广东广州510120；9北京大学肿瘤医院，北京100142；10西安交通大学第一附属医院，陕西西安710061
  • 出版日期:2016-09-01 发布日期:2016-08-24

  • Online:2016-09-01 Published:2016-08-24

摘要：

目的    对比非离断式（Uncut）Roux-en-Y吻合和传统Roux-en-Y吻合应用于全腹腔镜远端胃癌根治术后消化道重建的安全性和短期疗效。方法    回顾性分析国内10家单位共60例远端胃癌根治术后全腹腔镜消化道重建的胃癌病人临床资料，根据消化道重建方式不同分为Uncut Roux-en-Y组（Uncut组）34例，传统Roux-en-Y组（传统组）26例。结果　Uncut Roux-en-Y吻合在消化道重建时间方面用时更短［（51.5±13.3） min vs.（80.4±16.2） min，P＝0.000］，出血量更少［（60.0±35.6） mL vs. （132.9±65.1）mL，P＝0.000］，且在进食半流饮食时间方面具有优势［（4.6±1.5）d vs. （7.2±2.3）d，P＝0.000］。两组病人在留置胃管时间、术后排气时间、进食流质时间和术后住院时间方面差异无统计学意义。两组病人均无围手术期死亡病例，并发症发生率差异无统计学意义（8.8% vs. 7.7%，P＝0.875）结论　Uncut Roux-en-Y吻合和传统Roux-en-Y吻合应用于全腹腔镜下消化道重建安全可行，Uncut Roux-en-Y吻合在重建时间和控制出血量方面具有优势。

关键词: 胃癌, 腹腔镜, 胃切除术, 非离断式Roux-en-Y吻合, Roux-en-Y吻合

Abstract:

Comparison of uncut Roux-en-Y anastomosis and traditional Roux-en-Y anastomosis in the totally laparoscopic distal gastrectomy for gastric cancer: An analysis of multiple centers’ data        FENG Xing-yu *, YANG Li, ZHU Jia-ming, et al. *Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
Corresponding author: LI Yong, E-mail：yuan821007@126.com
Abstract    Objective    To compare the security and short-term effect of the digestive tract reconstruction during the totally laparoscopic distal gastrectomy for gastric cancer between the Uncut Roux-en-Y anastomosis and the traditional Roux-en-Y anastomosis. Methods    The clinical data of 60 gastric cancer patients with digestive reconstruction underwent totally laparoscopic distal gastrectomy between December 2012 and June 2015 in 10 domestic hospital were analyzed retrospectively. According to the difference of digestive reconstruction，it can be divided into the Uncut Roux-en-Y anastomosis group with 34 patients and the traditional Roux-en-Y anastomosis group with 26 patients. Results    In uncut Roux-en-Y anastomosis group，the operative time in digestive reconstruction was shorter ［（51.5±13.3） min vs.（80.4±16.2） min，P＝0.000］; the intraoperative blood loss was less［（60.0±35.6） mL vs. （132.9±65.1）mL，P＝0.000］; semi-liquid diet time was earlier［（4.6±1.5）d vs. （7.2±2.3）d，P＝0.000］. However，there was no difference between the two groups on nasogastric tube，gastrointestinal transit，fluid diet and the duration of postoperative hospital stay. Both groups had no death case during the perioperative period and there was no significant statistical difference in the postoperative complication rates（8.8% vs. 7.7%，P＝0.875）.  Conclusion    The Uncut Roux-en-Y anastomosis and the traditional Roux-en-Y anastomosis are both safe and feasible for the digestive reconstruction under the totally laparoscopic distal gastrectomy for gastric cancer. Besides，the Uncut Roux-en-Y anastomosis has other advantages such as less reconstruction time and less bleeding.

Key words: gastric cancer, laparoscopy, gastrectomy, Uncut Roux-en-Y anastomosis, Roux-en-Y anastomosis