双通道吻合技术在早期胃癌腹腔镜近端胃切除术消化道重建中的应用价值

目的:探讨双通道法应用于早期胃癌近端胃切除术中的临床价值及疗效。方法:回顾分析2015年1月至2016年12月接受腹腔镜胃癌D2根治术的41例胃癌患者的临床资料,其中19例于近端胃切除术中采用双通道法行消化道重建(双通道组),22例于全胃切除术中采用空肠食管吻合法行消化道重建(传统组)。对比分析两组手术时间、消化道重建时间、出血量、术后并发症、术后进食时间及住院时间。结果:两组均顺利完成手术,无一例中转开腹,双通道组消化道重建吻合时间(33.76±6.95)min vs.(34.5±5.12)min]、术中出血量(91.59±19.28)mL vs.(93.40±21.14)mL]、淋巴结清扫数量(28.00±5.21)枚vs.(27.40±4.47)枚]、术后排气时间(4.24±1.75)d vs.(4.25±2.10)d]及术后住院时间(12.53±3.28)d vs.(13.60±3.62)d]与传统组相比差异均无统计学意义;两组术后并发症发生率5.3%(1/19)vs.31.8%(7/22)]差异有统计学意义(P<0.05)。术后平均随访(23±11)个月,双通道组出现肠梗阻1例(5.3%),无远期并发症发生;传统组出现反流性食管炎2例(9.1%),营养不良5例(22.7%);两组均无肿瘤复发及死亡病例。结论:近端胃切除术中采用双通道吻合法较空肠食管(Roux-en-Y)吻合法更具优势,值得进一步推广应用。

Application of double-channel anastomosis in gastrointestinal reconstruction after laparoscopic proximal gastrectomy for gastric cancer

Objective:To explore the application value and therapeutic effect of dual-channel method in proximal gastrectomy for gastric cancer.Methods:Retrospective analysis wad made on the clinical data of 41 patients with gastric cancer receiving laparoscopic D2 radical gastrectomy from Jan.2015 to Dec.2016.Nineteen cases were reconstructed by double-channel method(double-channel group)with proximal gastrectomy and twenty-two cases underwent total gastrectomy with esophagojejunostomy(traditional group)for the reconstruction of digestive tract.The operation time,digestive tract reconstruction time,bleeding volume,postoperative complications,postoperative feeding time and hospital stay were compared between the two groups.Results:The laparoscopic gastrectomy was successfully completed in two groups without conversion to open surgery.There were no statistically significant differences between the double-channel group and traditional group in anastomosis and reconstruction time of digestive tract(33.76±6.95)min vs.(34.5±5.12)min],intraoperative blood loss(91.59±19.28)mL vs.(93.40±21.14)mL],number of lymph node dissection(28.00±5.21)vs.(27.40±4.47)],postoperative exhaust time(4.24±1.75)d vs.(4.25±2.10)d],postoperative hospitalization time(12.53±3.28)d vs.(13.60±3.62)d].There was statistical difference in postoperative complications between the two groups5.3%(1/19)vs.31.8%(7/22)].After follow-up of(23±11)months,there was 1 case of intestinal obstruction in the double-channel group(5.3%)without long-term complications.There were 2 cases of reflux esophagitis(9.1%)and 5 cases of dystrophy(22.7%)in the traditional group.There were no tumor recurrence or death cases in the two groups.Conclusions:The double-channel anastomosis of proximal gastrectomy is superior to jejunal esophagus(Roux-en-Y)anastomosis,and is worthy of further application.