不同吻合器在腹腔镜远端胃癌根治术Roux-en-Y式吻合中的安全性及卫生经济学对比

目的:比较直线切割吻合器与圆形吻合器在腹腔镜辅助远端胃癌根治术Roux-en-Y吻合中的安全性与卫生经济学的差异。方法:回顾分析2017年8月至2019年2月192例接受腹腔镜辅助远端胃癌根治术并Roux-en-Y式吻合患者的临床资料。根据胃肠吻合所用吻合器材类型,将患者分为直线切割吻合器组(A组,n=40,20.8%)与圆形吻合器组(B组,n=152,79.2%)。比较两组手术安全性、术后消化道功能恢复及卫生经济学的差异。结果:A组术中出血量(59.75±38.397)mL vs.(63.29±67.792)mL,(P=0.752)]、手术时间(249.28±65.72)min vs.(255.03±62.67)min,P=0.609]、淋巴结清扫数量(30.68±11.74)枚vs.(32.43±12.61)枚,P=0.429]、Ⅱ度及以上并发症发生率7.5%(3/40)vs.7.9%(12/152),P=0.934]、手术耗材费用(中位数:30758元vs.32749元,P=0.064)及住院费用(中位数:70759元vs.70851元,P=0.527)与B组差异无统计学意义。A组术后首次排气时间(3.46±0.767)d vs.(3.98±1.190)d,P=0.013]、首次进流食时间(4.32±1.029)d vs.(4.91±0.996)d,P=0.020]、拔除腹腔引流管时间(6.00±0.882)d vs.(6.56±1.764)d,P=0.008]均短于B组,差异均有统计学意义。结论:腹腔镜辅助远端胃癌根治术Roux-en-Y吻合中使用直线切割吻合器或圆形吻合器行消化道重建均是安全、可行的,使用直线切割吻合器术后首次排气时间、首次进流食时间更短,在术后胃肠道功能恢复方面存在优势。

Comparison of the safety and the health economics of different staplers in Roux-en-Y reconstruction after laparoscopic assisted distal gastrectomy

Objective:To compare the safety and health economics between linear stapler and circular stapler in Roux-en-Y reconstruction after laparoscopic assisted distal gastrectomy for gastric cancer.Methods:Clinical data of gastric cancer patients who received laparoscopic assisted distal gastrectomy with Roux-en-Y reconstruction from Aug.2017 to Feb.2019 were retrospectively analyzed.A total of 192 patients were enrolled and were divided into linear stapler group(40 cases,20.8%)and circular stapler group(152 cases,79.2%)according to the application of mechanical stapler.Operative safety,postoperative recovery and health economics were compared between two groups.Results:There were no significant differences between two groups in mean intraoperative blood loss(59.75±38.397)mL vs.(63.29±67.792)mL,P=0.752],mean operating time(249.28±65.72)min vs.(255.03±62.67)min,P=0.609],total retrieved lymph nodes(30.68±11.74)vs.(32.43±12.61),P=0.429],Ⅱdegree and above morbidity of postoperative complication7.5%(3/40)vs.7.9%(12/152),P=0.934],median cost of surgical consumables(30758 yuan vs.32749 yuan,P=0.064)and median hospitalization costs(70759 yuan vs.70851 yuan,P=0.527).However,the mean time to the first flatus(3.46±0.767)d vs.(3.98±1.190)d,P=0.013],the mean time to the first intake of liquid diet(4.32±1.029)d vs.(4.91±0.996)d,P=0.020]and the mean time to remove the abdominal drainage tube(6.00±0.882)d vs.(6.56±1.764)d,P=0.008]of the patients in linear stapler group were shorter than that those in circular stapler group.Conclusions:Linear stapler and circular stapler are both safe and feasible in Roux-en-Y reconstruction after laparoscopic assisted distal gastrectomy for gastric cancer.However,the advantage is obvious with linear stapler in sooner first flatus,sooner first intake of liquid diet and quicker postoperative recovery of gastrointestinal function.