三种不同术式在腹腔镜胃癌根治术消化道重建中的应用

目的探讨Billroth-Ⅱ、Roux-en-Y及改良非离断式Roux-en-Y技术在腹腔镜胃癌根治术消化道重建中的应用。方法选取2019年2月至2020年12月间商丘市第一人民医院收治的143例实施腹腔镜胃癌根治术患者进行回顾性分析。根据手术方式分为三组,A组46例患者采用Billroth-Ⅱ吻合,B组49例患者采用Roux-en-Y吻合,C组48例患者采用改良非离断式Roux-en-Y技术吻合,比较三组手术指标以及营养指标、生活质量分级、术后并发症发生率。结果三组吻合时间、总蛋白、前白蛋白、白蛋白和住院时间比较,差异无统计学意义(P> 0.05)。A组术中出血量少于B组、C组,手术耗时、消化道重建时间短于B组、C组,差异均有统计学意义(均P <0.05)。C组手术耗时、术后排气时间和消化道重建时间短于B组,术中出血量少于B组,差异均有统计学意义(均P <0.05)。同时C组术后14dⅠ级率高于A组、B组,术后并发症发生率低于A组、B组,差异均有统计学意义(均P <0.05)。结论三种常见重建方式各具有优劣性,改良非离断式Roux-en-Y吻合术虽操作复杂,不符合生理通道,但安全性较高,可降低术后并发症。术者需根据患者实际问题合理选择消化道重建方式。

Application of three types of procedures for reconstruction of gastrointestinal tract in laparoscopic radical surgery for gastric cancer

Objective To explore the application of Billroth-Ⅱ,Roux-en-Y and modified non-disconnected Roux-en-Y techniques in reconstruction of gastrointestinal tract in laparoscopic surgery for radical gastric cancer. Methods A retrospective analysis of 143 patients undergoing laparoscopic radical surgery for gastric cancer were selected at Shangqiu First People’s Hospital between February 2019 and December 2020. They were categorized into 3 groups based on the surgical approaches. Forty-six patients in group A underwent surgery with Billroth-Ⅱ anastomosis,and group B underwent surgery with Roux-En-Y anastomosis and group C underwent surgery with modified non-disconnected Roux-en-Y anastomosis. Surgical indicators,nutritional indicators,quality of life classification,and the incidence of postoperative complications were compared among the three groups. Results There was no significant difference in the anastomotic time,total protein,prealbumin,albumin,and length of hospital stay among the three groups(P > 0. 05).The intraoperative blood loss was less in group A than in group B and group C(all P < 0. 05). The duration of operation and reconstruction of digestion tract was shorter in group A than in group B and group C(all P < 0. 05). The operation time,time to postoperative exhaust,gastrointestinal reconstruction time and intraoperative blood loss was lesser in group C than in group B(all P < 0. 05). Moreover,the grade I rate was higher in group C than in group A and group B(all P < 0. 05),and the incidence of postoperative complications was lower in group C than in group A and group B(all P < 0. 05). Conclusion The three common reconstruction approaches have their own advantages and disadvantages. Although the modified non-disruptive Roux-en-Y anastomosis is complicated and does not conform to the physiological pathway,it is safe and can reduce postoperative complications. The surgeon needs select a reasonable gastrointestinal reconstruction approach based on the actual condition of a patient.