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。

Clinical analysis of modified SPLT anastomosis in laparoscopic D2 total gastrectomy in treating advanced gastric cancer

Objective To explore the clinical outcome of laparoscopic D2 total gastrectomy with self-pulling and transected esophagojejunostomy(SPLT)anastomosis for advanced gastric cancer.Methods Retrospective analysis were performed on the data of 96 patients with advanced gastric cancer who received laparoscopic D2 total gastrectomy from April 2016 to October 2019.According to different anastomosis methods,the patients were divided into two groups:the patients in the improved group received modified SPLT anastomosis,while Roux-en-Y anastomosis were performed in the traditional group.Statistical analysis were performed by using SPSS23.0 software.,Measurement data such as intraoperative and postoperative conditions,pain scale score were expressed as and were analyzed by using t test.Complications were tested by usingχ² test.A P value of<0.05 was considered as statistically significant difference.Results The operative time,anastomosis time,intraoperative blood loss,postoperative first defecation time,first feeding time,first ambulation time and postoperative pain score on POD5 were significantly lower in the improved group than those in the traditional group respectively(P<0.05).The postoperative complications incidence of 10.4%in the improved group was lower than 27.1%in the traditional group(P<0.05).Conclusion Compared with traditional methods,laparoscopic D2 total gastrectomy for gastric cancer patients by using modified SPLT anastomosis is safe and reliable,it has the advantages of shorter operation time,less intraoperative blood loss,less postoperative pain and complications.