Roux-en-Y吻合方案对腹腔镜全胃切除术消化道重建患者疗效及安全性的影响

目的 探讨常规Roux-en-Y吻合方案与Uncut Roux-en-Y吻合方案对腹腔镜全胃切除术消化道重建患者疗效及安全性的影响。方法 回顾性分析济源市第二人民医院2013年1月至2017年12月收治的行腹腔镜全胃切除术消化道重建患者共154例的临床资料，其中102例采用常规Roux-en-Y吻合方案，设为对照组；52例采用Uncut Roux-en-Y吻合方案，设为观察组。比较两组围手术期临床指标水平、术后并发症发生率、营养指标水平及随访生存情况。结果 观察组手术出血量少于对照组（P＜0.05）；观察组术后肛门排气恢复时间少于对照组（P＜0.05）；观察组术后食物襻排空异常和RY滞留综合征发生率均低于对照组（P＜0.05）；两组手术前后体重指数（BMI）、血红蛋白（HGB）、白蛋白（ALB）及总蛋白（TP）比较，差异无统计学意义（P＞0.05）；两组随访生存情况比较，差异无统计学意义（P＞0.05）。结论 行腹腔镜全胃切除术消化道重建患者采用Uncut Roux-en-Y吻合方案可有效减少手术出血量，加快术后胃肠功能恢复，降低术后食物襻排空异常和RY滞留综合征发生风险，且未影响营养状态和生存情况，价值优于常规Roux-en-Y吻合方案。

Effect of Roux-en-Y anastomotic scheme on the efficacy and safety of patients undergoing digestive tract reconstruction after laparoscopic total gastrectomy

Objective To investigate the effect of Roux-en-Y and Uncut Roux-en-Y on the efficacy and safety of patients undergoing digestive tract reconstruction after total gastrectomy. Methods The clinical data of 154 patients underwent digestive tract reconstruction after laparoscopic total gastrectomy from Jan. 2013 to Dec. 2017 in the Second People’s Hospital of Jiyuan were analyzed retrospectively, of whom 102 patients were treated with Roux-en-Y anastomotic scheme (the control group) and 52 patients were treated with Uncut Roux-en-Y anastomotic scheme (the observation group). The levels of perioperative clinical indicators, incidence rate of postoperative complication, nutritional indicators and follow-up survival were compared between the two groups. Results The amount of bleeding in the observation group was significantly less than that in the control group (P<0.05). The recovery time of anal exhaust in the observation group was significantly shorter than that in the control group (P< 0.05). The incidence of abnormal emptying of food loop and RY retention syndrome in the observation group was significantly lower than that in the control group (P<0.05). There was no significant difference in BMI, HGB, ALB or TP between the two groups (P>0.05). There was no significant difference between the two groups in follow-up survival (P>0.05). Conclusion Uncut Roux-en-Y anastomotic scheme can effectively reduce the amount of bleeding, accelerate the recovery of gastrointestinal function, and reduce the risk of abnormal emptying of food loop and RY retention syndrome, while it does not affect the nutritional status and survival of patients, which is superior to Roux-en-Y anastomotic scheme for patients undergoing digestive tract reconstruction after laparoscopic total gastrectomy.