非离断式Roux-en-Y吻合技术在腹腔镜辅助远端胃切除中的应用

目的初步研究非离断式Roux-en-Y吻合技术在腹腔镜辅助远端胃切除中应用的安全性、可靠性以及远期疗效。方法回顾性分析铜陵市人民医院胃肠外科2016年9月至2017年9月收治的6例行腹腔镜辅助远端胃切除联合非离断式Roux-en-Y吻合病例资料,行相关临床观察并对病人进行长期随访。结果 6例病人均成功实施计划手术,无中转开腹病例,无术中器官及组织副损伤情况。肿瘤距下切缘距离(4.5±1.3) cm,肿瘤距上切缘距离(7.9±1.6) cm,平均淋巴结清扫数量27.6枚。本组病人术后恢复顺利,均康复出院,术后平均住院时间10.6 d,无严重术后并发症发生。病人术后6个月时均行上消化道碘水造影检查,5例病人造影剂均在30 min中内完全排空,1例病人出现食管造影剂反流,无反酸及餐后反流症状。结论非离断式Roux-en-Y吻合是一种安全可靠的消化道重建方式,能够有效地避免胃排空障碍和胆汁反流的发生,特别适合于分期较晚或肿瘤较大的胃窦癌病人。

Clinical application of uncut Roux-en-Y reconstruction after laparoscopic assisted distal gastrectomy

Objective To investigate the safety,reliability and long-term outcome of laparoscopic assisted distal gastrectomy with uncut Roux-en-Y anastomosis. Method The clinical data of 6 patients who underwent laparoscopic-assisted distal gastrectomy combined with uncut Roux-en-Y anastomosis from September 2016 to September 2017 in the Department of Gastrointestinal Surgery of Tongling People's Hospital were retrospectively analyzed.Clinical observation and long-term follow-up were performed. Result The planned operation was successfully performed in this group of patients,and there was no conversion to laparotomy,and there was no intraoperative injury of organs and tissues.The distance from tumor to the inferior margin was (4.5±1.3) cm and(7.9±1.6) cm to the superior margin.The average number of dissected lymph nodes was 27.6.All patients in this study recovered smoothly,and the average of postoperative length of stay was 10.6 d.No serious postoperative complications occurred.All patients underwent upper gastrointestinal iodine hydrography at 6 months after operation.5 patients had complete emptying of contrast medium within 30 minutes,and 1 patient had esophageal contrast agent reflux without acid reflux and postprandial reflux symptoms. Conclusion Uncut Roux-en-Y is a safe and reliable method for digestive tract reconstruction,which can effectively avoid gastric emptying and bile reflux.