完全腹腔镜与腹腔镜辅助胃癌根治术近期疗效比较

目的:探讨完全腹腔镜胃癌根治术(TLG)与腹腔镜辅助胃癌根治术的近期疗效。方法:收集2013年5月—2016年5月期间在南昌大学第二附属医院胃肠外科治疗的435例胃癌患者资料,其中207例行TLG(TLG组),228例行LAG(LAG组)。比较两组患者相关临床指标。结果:两组患者术前资料具有可比性,所有患者的手术均成功完成,无中转开腹。与LAG组比较,TLG组淋巴结清扫数目差异无统计学意义(23.64枚vs.24.69枚,P=0.14),手术时间(204.34 min vs.214.65 min)、吻合时间(33.00 min vs.38.86 min)、术中出血量(185.20 m L vs.210.02 m L)、切口长度(3.88 cm vs.8.05 cm)、术后下床活动时间(1.71 d vs.2.59 d)、肛门排气时间(2.63 d vs.3.51 d)、术后第1、3天疼痛评分(3.01分vs.4.86分;1.88分vs.3.53分)、术后住院时间(12.23 d vs.15.96 d)均明显减少(均P0.05)。TLG组与LAG组患者术后并发症发生率(2.4%vs.2.6%,P=0.89)以及随访12个月的中位生存时间(11.07个月vs.10.91个月)均无统计学差异(均P0.05)。结论:TLG安全、可行,且近期疗效优于LAG。     

全腹腔镜远端胃癌根治术中2种吻合方式临床疗效的对比

目的:分析Uncut Roux-en-Y与B-Ⅱ+Braun 2种吻合方式在全腹腔镜远端胃癌根治术中消化道重建效果的差异。方法:选取2015年6月—2016年12月收治的胃癌患者88例,以随机数字表法分为观察组和对照组各44例,两组患者均行全腹腔镜远端胃癌根治术,观察组选择Uncut Roux-en-Y吻合,对照组选择B-Ⅱ+Braun吻合。比较两组患者围术期情况、术中出血情况及术后并发症发生情况。结果:两组术中出血量、手术时间、首次进食时间、住院时间比较差异无统计学意义(P0.05),观察组肠道恢复时间(肠鸣音4～5次/min)、术后首次排气时间均显著低于对照组(P0.05);两组吻合口瘘、创面感染、胃瘫、倾倒综合征发生率差异无统计学意义(P0.05),但观察组术后小肠梗阻、食管反流发生率明显低于对照组,差异有统计学意义(P0.05)。结论:Uncut Roux-en-Y与B-Ⅱ+Braun 2种吻合方式在全腹腔镜远端胃癌根治术中消化道重建效果良好,Uncut Roux-en-Y吻合方式患者术后功能恢复快,食管反流发生少,值得在胃癌远端切除中推荐使用。     

完全腹腔镜胃癌D2根治术150例报道

目的研究完全腹腔镜下D2淋巴结清扫胃癌根治术（TLG）的安全性和可行性。方法回顾性分析2009年7月至2012年6月行TLG（TLG组）与腹腔镜辅助下D2淋巴结清扫胃癌根治术（LAG）（LAG组）共601例患者的临床资料,手术均由同一手术组完成。结果 TLG组150例中行远端胃切除68例,全胃切除82例。LAG组451例中远端胃切除214例,全胃切除237例。TLG组平均手术时间292min,LAG组平均手术时间为269min（P〈0.05）。TLG组平均住院时间为10.9d,LAG组平均为12.1d（P〈0.05）。术后镇痛泵的使用时间TLG组平均为6.3（0~12）h,而LAG组为21.1（0~48）h（P〈0.05）。术后平均通气时间两者分别为3.2d和3.4d（P〈0.05）。术后首次进流质饮食时间TLG组平均为3.5d,LAG组为3.7d（P〈0.05）。随访时间1~37个月（平均随访时间16.7个月）,TLG组出现并发症15例,LAG组73例,两组均无手术死亡发生。结论相较于LAG,TLG具有可接受的手术时间与并发症发生率,患者术后疼痛轻,舒适感强,通气及下床活动时间早,住院时间缩短,可作为胃癌患者一种理想的手术方法。     

腹腔镜远端胃癌根治术非离断空肠Roux-en-Y吻合对术后胃食管反流的影响

探讨腹腔镜远端胃癌根治术非离断空肠Roux-en-Y吻合对术后胃食管反流的影响。选取我院2016年4月至2019年4月96例腹腔镜远端胃癌根治术患者作为研究对象,根据术中消化道重建方式分为研究组和对照组各48例。研究组采用非离断空肠Roux-en-Y吻合,对照组采用BillrothⅡ式+Braun式吻合术。比较两组患者手术时间、切口长度、术后肛门排气时间、术后进食流质饮食时间、住院时间、术后不同时间胃液pH值、术后患者胃食管反流病自测表(GerdQ量表)评分及手术并发症发生率。两组手术时间、切口长度、术后肛门排气时间、术后进食流质饮食时间、住院时间比较差异均无统计学意义(P0.05);两组术前及术后第1、3、5 d胃液pH值比较,差异亦无统计学意义(P0.05);术后3个月对两组胃食管反流症状进行评估,研究组阳性症状、阴性症状、阳性影响因素评分均高于对照组,差异具有统计学意义(P0.05);两组术后并发症发生率比较,差异无统计学意义(P0.05)。腹腔镜远端胃癌根治术非离断空肠Roux-en-Y吻合方式能够一定程度上减轻术后患者胃食管反流。     

完全腹腔镜与腹腔镜辅助远端胃癌根治术的 近期临床疗效对比研究

目的:对比完全腹腔镜与腹腔镜辅助远端胃癌根治术的短期临床疗效,探讨完全腹腔镜下远端胃癌根治术的安全性及可推广性。方法:回顾分析2016年1月至2018年7月施行完全腹腔镜远端胃癌根治术(完全组,n=36)与腹腔镜辅助下远端胃癌根治术(辅助组,n=42)的临床资料。结果:完全组胃肠吻合时间[(24.2±11.5) min vs.(26.1±10.3) min,t=-4.719,P=0.684]、术中出血量[(42.0±9.5) m L vs.(52.0±11.5) m L,t=-0.792,P=0.416]与辅助组相比差异无统计学意义,但切口长度[(3.0±2.0) cm vs.(6.5±2.5) cm,t=-19.134,P<0.001]、肛门排气时间[(2.0±0.7) d vs.(3.0±0.8) d,t=-8.177,P=0.001]、进食流质时间[(2.5±1.0) d vs.(3.2±0.8) d,t=-8.792,P<0.001]、住院时间[(9.1±1.2) d vs.(11.9±1.5) d,t=-11.921,P<0.001]优于辅助组,且术后患者需要止痛剂剂量[(2.5±1.0)支vs.(4.0±1.2)支,t=-13.713,P<0.001]少。完全组出现吻合口漏1例,辅助组均未发生吻合口相关并发症。结论:完全腹腔镜远端胃癌根治术安全、可行,具有创伤小、康复快、住院时间短、疼痛轻等优势,近期疗效显著。     

H形吻合在腹腔镜下远端胃癌根治术中的应用

目的:评价H形吻合在腹腔镜下远端胃癌根治术后消化道重建中的临床效果。方法:回顾分析2013年1月至2015年6月152例行腹腔镜下远端胃癌根治术且有完整随访资料患者的临床资料,根据其消化道重建方式分为:H形吻合组(n=20)、毕Ⅰ式吻合组(n=53)、毕Ⅱ式吻合组(n=58)及Roux-en-Y吻合组(n=21)。4组患者在年龄、性别、肿瘤大小、肿瘤分期及分级方面差异均无统计学意义。结果:H形吻合组手术时间及重建时间较毕Ⅰ式有所增加,且重建时间两者差异有统计学意义,与毕Ⅱ式吻合组差异无统计学意义,较Roux-en-Y吻合组明显缩短,差异有统计学意义;H形吻合组术中出血量少于毕Ⅰ式吻合组,差异有统计学意义。术后每日胃肠减压量、术后进流质饮食时间明显少于其他三组,差异有统计学意义。H形吻合组术后排气时间明显缩短,与Roux组相比差异有统计学意义。H形吻合组无术后吻合口狭窄、出血、吻合口漏等并发症发生。结论:H形吻合能明显降低手术时间,减少术后排气时间、胃潴留、吻合口梗阻等并发症,是远端胃癌根治术后理想的消化道重建方式。     

全腹腔镜、腹腔镜辅助与开腹胃癌根治术治疗Ⅱ、Ⅲ期胃癌的疗效对比

目的探讨全腹腔镜胃癌根治术（TLG）、腹腔镜辅助胃癌根治术（LAG）与传统开腹术（TOS）对Ⅱ、Ⅲ期胃癌的近期及远期疗效。 方法回顾性分析2013年1月至2016年6月陕西中医药大学附属医院行胃癌根治术的患者共136例，根据患者手术方式的不同分为TLG组（45例），LAG组（40例），TOS组（51例）。观察和比较3组患者手术时间、出血量、淋巴结清扫数、术后排气时间、住院时间、术后并发症发生情况，采用Kaplan-Meier法对患者术后5年远期疗效进行生存分析。 结果TLG组患者出血量、排气时间及住院时间低于TOS组及LAG组，LAG组患者手术时间高于TLG组及TOS组，差异均有统计学意义（P<0.05）；3组患者术后并发症发生率比较，差异无统计学意义。共129例获得随访，其中TLG组失访2例，LAG组2例，TOS组3例。TLG、LAG、TOS组平均无瘤生存时间为（53.4±2.1）个月（95%CI=50.45~58.22个月）、（54.3±2.0）个月（95%CI= 47.99~56.18个月）、（52.3±2.1）个月（95%CI=50.98~55.65个月），3组患者无瘤生存时间比较，差异无统计学意义（F=0.519，P=0.772）。 结论TLG术能够在保证患者术后疗效的同时，降低患者术中出血量、排气时间及术后住院时间，TLG术治疗Ⅱ、Ⅲ期胃癌安全可行，疗效显著，值得推广。     

完全腹腔镜与腹腔镜辅助胃癌根治术的比较

目的 研究缝合重建完全腹腔镜下胃癌根治术与腹腔镜辅助下胃癌根治术的优缺点,探讨在完全腹腔镜下缝合重建吻合方式的安全性与可行性.方法 回顾性分析2009年7月至2010年7月在第四军医大学西京消化病医院完全腹腔镜下缝合重建胃癌D2根治术与腹腔镜辅助胃癌D2根治术49例患者的临床资料,手术均由同一位经验丰富的普通外科医师完成.结果 完全腹腔镜胃癌根治21例中行远端胃切除15例,全胃切除6例,均采用镜下手工缝合胃肠吻合和空肠-空肠吻合,应用25mm管型吻合器完成食管空肠吻合;腹腔镜辅助胃癌根治28例中行远端胃切除21例,全胃切除7例.完全腹腔镜组与腹腔镜辅助组平均手术时间分别为(279±65)min、(232±40)min(P＜0.05),平均肿瘤下切缘为(3.1±0.9)cm、(2.9±0.9)cm(P＞0.05),平均上切缘为(5.7±1.5)cm、(5.1±1.4)cm(P＞0.05),两组切缘均无癌残留.完全腹腔镜组术后无需用镇痛药,腹腔镜辅助组平均使用镇痛药1.8 d;完全腹腔镜组术后通气时间为3 d,腹腔镜辅助组为4.8 d;完全腹腔镜组术后发生早期并发症2例,其中1例腹腔感染,1例肺部感染.腹腔镜辅助组2例,其中1例切口感染,1例肺部感染.术后中位随访时间4个月,两组均无吻合口瘘与狭窄发生.结论 完全腹腔镜下缝合重建的胃癌D2根治术具有可以接受的手术时间和早期并发症的发生率,可在有选择的患者中由经验丰富的外科医师应用.

Abstract：

Objectives To compare total laparoscopic gastrectomy with intracorporeal hand-sewn Gl reconstruction and laparoscopy-assisted gastrectomy for gastric cancer. Methods Between July 2009 and July 2010, 21 patients of gastric cancer underwent total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn reconstruction and 28 did laparoscopy-assisted D2 radical gastrectomy in Xijing Hospital of Digestive Diseases. All patients were operated on by an experienced surgeon. Patient demographics, TNM stage, location of tumor, the intraoperative and postoperative details of the two groups were compared. Results In the 21 patients undergoing total laparoscopic gastrectomy, there were 15 of distal gastrectomy and 6 of total gastrectomy, compared with 21 and 7 in laparoscopy-assisted group. In total laparoscopic group, intracorporeal hand-sewn technique was used for gastro-jejunal and jejuno-jejunal (J-J)anastomosis, and 25 mm circular stapler was used for esophago-jejunal anastomosis. The operation time was significant longer in total laparoscopic group than in laparoscopy-assisted group of (279 ± 65 ) min vs.(232 ±40) min (P ＜ 0.05 ). No significant difference was observed between the two groups in proximal margin [(5.7 ± 1.5 )cm vs. (5.1 ± 1.4) cm, P ＞ 0.05] and distal margin [( 3.1 ± 0.9 )cm vs. ( 2.9 ±0.9) cm,P ＞0.05]. The iv narcotic use in laparoscopy-assisted group was 1.8 d but it was not used in total laparoscopic group. The first passing flatus was on day 3 in total laparoscopic group compared with 4.8 d in laparoscopy-assisted group. Both groups had 2 postoperative early complications, one intra-abdominal infection and one lung infection in total laparoscopic group compared with one wound infection and one lung infection in laparoscopy-assisted group. There was no anastomosis-related complications after 4 months of follow-up. Conclusions The operation time and postoperative early complication was acceptable for selected patients treated by total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn GI tract reconstruction in hands of experienced laparoscopic surgeon.     

腹腔镜辅助远端胃癌根治术改良Uncut Roux-en-Y吻合对患者预后的影响

目的探讨腹腔镜辅助远端胃癌根治术Uncut Roux-en-Y(U-RY)吻合与改良U-RY吻合的临床效果。方法回顾性分析2017年1月至2019年6月接受腹腔镜辅助远端胃癌根治术治疗的92例患者资料,按照不同吻合术式分为两组,其中44例行U-RY吻合为U-RY组;48例行改良U-RY吻合为改良组。采用统计软件SPSS 21.00进行数据分析,围术期各项指标等计量资料采用■表示,独立t检验;并发症发生情况比较采用χ~2检验;P0.05为有差异统计学意义。结果改良组手术时间、首次通气和住院时间少于U-RY组(P0.05);改良组术后并发症总发生率14.6%(7/48)小于U-RY组29.5%(13/44);术后随访1年,U-RY组患者共发生闭合点再通发生率9.1%,改良组暂无闭合点再通发生(0%),两组比较差异均无统计学意义(P0.05)。结论腹腔镜辅助远端胃癌根治术中应用改良U-RY吻合安全可行,较传统U-RY吻合术吻合,术后恢复快,可一定程度降低闭合口再通的发生率,可在临床推广使用。     

三角吻合在完全腹腔镜远端胃癌根治术中的应用研究

目的 对比分析远端胃癌根治术中全腹腔镜下三角吻合与腹腔镜辅助Brillroth Ⅰ式吻合的近期疗效,探讨三角吻合技术的应用价值.方法 回顾性分析2013年3月至2014年2月开展的50例全腹腔镜下远端胃癌根治术加三角吻合的临床资料（三角吻合组）,并以同期开展的43例腹腔镜辅助远端胃癌根治术加Brillroth Ⅰ吻合作为对照（BⅠ吻合组）,比较两组患者的手术相关指标和术后并发症发生情况.结果 两组手术时间、术中出血量、淋巴结清除数、术后肛门排气时间、并发症发生率和术后住院天数比较,差异均无统计学意义（均P＞0.05）;三角吻合组切口长度[（3.4±0.4）cm]和术后第1天疼痛评分[（3.1±1.0）]小于BⅠ吻合组[（6.9±0.8）cm和（4.6±1.4）],差异均有统计学意义（均P＜0.05）.结论 全腹腔镜下远端胃癌根治术三角吻合技术安全可行,在切口美观和舒适度方面较腹腔镜辅助下Brillroth Ⅰ式吻合更有优势。     

非离断式Roux－en－Y吻合在全腹腔镜根治性全胃切除术消化道重建中的可行性研究

目的探究非离断式Roux－en－Y吻合在全腹腔镜根治性全胃切除术消化道重建中的安全性及可行性。 方法回顾性分析2015年6月至2017年5月接受全腹腔镜根治性全胃切除术的75例胃癌患者临床资料,根据术中消化道重建术式不同进行分组,非离断组37例,行非离断式Roux－en－Y吻合,传统组38例行传统Roux－en－Y吻合。采用统计软件SPSS 20.0进行数据分析,围手术指标、血清营养指标等计量资料采用( ±s)表示,行独立t检验;近远期并发症等行χ²检验或Fisher检验,P<0.05差异有统计学意义。 结果非离断组在手术总时间、消化道重建时间、术中出血量、恢复排气时间、首次进食时间、住院时间方面明显优于传统组(P<0.05),两组术中均无中转开腹。传统组近、远期并发症总发生率(13.2%、21.1%)明显高于非离断组(2.7%、5.4%),差异有统计学意义(P<0.05)。非离断组患者术后短期疗效及胆汁反流情况均优于传统组(P<0.05)。术后3个月两组血清营养指标逐渐恢复,非离断组高于传统组(P<0.05)。 结论非离断式Roux－en－Y吻合应用于全腹腔镜根治性全胃切除术消化道重建中安全可行,值得临床推广使用。     

ȫ��ǻ��Զ��θ�������������ʽRoux-en-Y�Ǻ��봫ͳ�Ǻ���Ч���ն������о�

??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.     

改良SPLT吻合的腹腔镜全胃癌切除D2根治术治疗进展期胃癌的临床效果研究

目的探究改良自牵引后离断食管空肠(SPLT)吻合的腹腔镜全胃癌切除D2根治术治疗进展期胃癌的临床效果。方法回顾性分析2016年4月至2019年10月间接受腹腔镜全胃癌切除D2根治术治疗的96例进展期胃癌患者资料,按照消化道重建吻合方式不同分为两组:行改良SPLT吻合设为改良组;行食管空肠roux-en-y吻合设为传统组,每组48例。采用SPSS23.0进行统计学分析,其中术中和术后情况、疼痛量表评分等计量资料(±s)表示,独立样本t检验;并发症等计数资料采用χ²检验,P<0.05差异有统计学意义。结果改良组患者的手术时间、吻合时间、术中出血量、术后首次排便时间、首次进食时间、首次下床活动时间和术后5 d疼痛评分均明显少于传统组(P<0.05);改良组术后总并发症发生率为10.4%低于传统组27.1%(P<0.05)。结论腹腔镜全胃癌切除D2根治术患者行改良SPLT吻合方法安全可靠,与传统方法比,具有手术时间短、术中出血量少、术后疼痛轻和并发症少的优势。     

Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience

Background We analyzed our preliminary clinical data for totally laparoscopic gastrectomy (TLG) in order to evaluate its effectiveness in terms of minimal invasiveness, technical feasibility, and safety. Methods Forty-five consecutive patients who underwent TLG in our institution between June 2004 and February 2006 were enrolled in this study. There were 26 men and 19 women, with a mean age of 58.8 years and a mean body mass index (BMI) of 23.2. In all cases, only laparoscopic linear staplers were used for intracorporeal anastomosis. Results The reasons that gastrectomy was performed were adenocarcinoma in 41 cases, benign disease in three cases and gastrointestinal stromal tumor in one case, and the types of surgery were distal gastrectomy (40), total gastrectomy (four) and pylorus-preserving gastrectomy (one). Among the distal gastrectomies, Billroth I (25) was the most frequent procedure, followed by uncut Roux-en-Y gastrojejunostomy (14) and Billroth II (one), respectively. The mean operation time was 314 minutes, the mean anastomotic time was 41 minutes, the mean number of staples used was eight, and the mean estimated blood loss was 150 ml. There was no case of conversion to an open procedure. The first flatus was observed at 2.9 days, and liquid diet was started at 3.7 days. The mean number of postoperative analgesic use, except for patient-controlled analgesia (PCA), was 1.4 times, and the mean postoperative hospital stay was 11 days. Postoperative complication occurred in six patients (13.3 %), but no postoperative mortality occurred. There were two cases of delayed gastric empting and one case of anastomotic leakage, anastomotic stenosis, intraabdominal bleeding, and ventral hernia each. All of the patients recovered well with conservative or surgical management. Conclusions TLG with intracorporeal anastomosis using laparoscopic linear staplers was safe and feasible, and we were able to obtain acceptable surgical outcomes in terms of minimal invasiveness.     

ȫ��ǻ��Զ��θ��������θ�ճ������ʽRoux-en-Y�Ǻ�51����Ч����

??Uncut Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy??A clinical study of 51 cases MA Jun-jun??ZANG Lu?? HU Wei-guo??et al. Department of Gastrointestinal Surgery??Rui-Jin Hospital??Shanghai Jiao-Tong University School of Medicine; Shanghai Minimal Invasive Surgery Center??Shanghai 200025??China
Corresponding author??ZANG Lu??E-mail??zanglu@yeah.net
Abstract Objective To investigate the safety, feasibility and short term outcome of totally laparoscopic uncut Roux-en-Y anastomosis in the distal gastrectomy with D2 dissection for gastric cancer. Methods The clinical data of 51 cases of total laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D2 dissection for gastric cancer from September 2014 to December 2015 in Rui-Jin Hospital??Shanghai Jiao-Tong University School of Medicine were analyzed retrospectively. The operation time, intraoperative bleeding volume, number of lymph nodes resected, incidence of complication, length of hospital stay and follow-up were observed. Results All of them underwent total laparoscopic uncut Roux-en-Y anastomosis. All the procedures were performed successfully.There were neither conversions to open surgery??nor intraoperative complications in all 51 cases. The median time of the operation was 170 (135-210) min and the median time of anastomosis was 27(24-41) min. The blood loss was 60 (30-110) mL. The time to flatus and length of postoperative hospital stay were 2 (1-3) d and 8(7-12) d??respectively. One anastomotic bleeding occurred which was cured by conservative treatment. No major postoperative complication occurred??such as anastomotic leak??anastomotic stenosis and Roux stasis syndrome. After a short-term follow up [9(5-20)months]??no recanalization or reflux gastritis was encountered by endoscopy. Conclusion The totally laparoscopic uncut Roux-en-Y anastomosis in distal gastrectomy with lymph node dissection for gastric cancer is safe and feasible??with a very low rate of recanalization and reflux gastritis.     

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

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。     

不同消化道重建方式在腹腔镜远端胃癌根治术的应用对比研究

目的探讨Uncut Roux－en－Y吻合、Roux－en－Y吻合与Billroth－II吻合在远端胃癌根治术消化道重建中的应用效果。 方法回顾性分析2016年1月至2019年1月94例行完全腹腔镜下胃癌根治术患者临床资料,根据不同消化道重建方式分组,其中A组28例行Uncut Roux－en－Y吻合、B组36例行Roux－en－Y吻合、C组30例行Billroth－II吻合。采用SPSS20.0统计软件进行数据分析,围术期指标等计量资料采用( ±s)表示,用单因素方差分析,组间两两比较采用t检验;术后并发症等计数资料采用χ²检验。P<0.05为差异有统计学意义。 结果A组在降低手术吻合时间和Roux淤滞综合征(RSS)明显优于B组(P<0.05);术中出血量和肛门恢复排气时间明显低于B组与C组(P<0.05);A组和B组在降低反流性胃炎和胆汁反流显著优于C组(P<0.05);在手术时间、恢复进食时间、术后住院时间、吻合口漏、溃疡、狭窄、出血及反流性食管炎等方面三组差异均无统计学意义(P>0.05)。 结论Uncut Roux－en－Y吻合术在胃癌根治术中具有操作简单、安全可行、降低术后并发症等特点,有效改善患者术后生活质量,值得临床推广。