[1]朱绍辉,侯　栋,薛明辉,等.胃癌腹腔镜辅助全胃切除术中不同食管-空肠吻合口加固方法的疗效及安全性比较[J].新乡医学院学报,2022,39(6):533-536.[doi:10.7683/xxyxyxb.2022.06.007]
　ZHU Shaohui,HOU Dong,XUE Minghui,et al.Comparison of the efficacy and safety of different esophagojejunostom reinforcement methods in laparoscopic assisted total gastrectomy for gastric cancer[J].Journal of Xinxiang Medical University,2022,39(6):533-536.[doi:10.7683/xxyxyxb.2022.06.007]
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胃癌腹腔镜辅助全胃切除术中不同食管-空肠吻合口加固方法的疗效及安全性比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年6
页码:
533-536
栏目:
临床研究
出版日期:
2022-06-05

文章信息/Info

Title:
Comparison of the efficacy and safety of different esophagojejunostom reinforcement methods in laparoscopic assisted total gastrectomy for gastric cancer
作者:
朱绍辉; 侯　栋; 薛明辉; 房祥杰; 孟　涛; 李鹏辉
（新乡医学院第一附属医院普外科，河南　卫辉　453100）
Author(s):
ZHU Shaohui; HOU Dong; XUE Minghui; FANG Xiangjie; MENG Tao; LI Penghui
（Department of General Surgery,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China）
关键词:
胃癌; 腹腔镜; 胃切除; 食管-空肠吻合
Keywords:
gastric carcinoma; laparoscopy; gastrectomy; esophagojejunostomy
分类号:
R735.2
DOI:
10.7683/xxyxyxb.2022.06.007
文献标志码:
A
摘要:
目的　比较胃癌腹腔镜辅助全胃切除术中Spiral PDO倒刺线连续全层加固食管-空肠吻合口和3-0可吸收抗菌微乔线间断全层加固食管-空肠吻合口的疗效及安全性。方法　选择2019年10月至2020年10月于新乡医学院第一附属医院普外科行腹腔镜辅助全胃切除术+食管-空肠Roux-en-Y手术治疗的58例胃癌患者为研究对象，根据食管-空肠吻合口加固方式将患者分为观察组（n=35）和对照组（n=23）。观察组患者应用Spiral PDO倒刺线连续全层加固食管-空肠吻合口，对照组患者应用3-0可吸收抗菌微乔线间断全层加固食管-空肠吻合口。比较2组患者的手术时间、食管-空肠吻合口加固时间、术中出血量、术后排气时间、住院时间以及术后出血、吻合口瘘、发热、切口感染、术后吻合口狭窄等并发症发生情况。结果　观察组患者食管-空肠吻合口加固时间为（6.37±1.69）min，手术时间为（327.00±49.82）min，术中出血量为（99.00±8.90）mL；对照组患者食管-空肠吻合口加固时间为（14.95±2.09）min，手术时间为（345.00±32.64）min，术中出血量为（112.90±9.59）mL；观察组患者食管-空肠吻合口加固时间短于对照组（t=16.200，P<0.01）；2组患者的手术时间、术中出血量比较差异无统计学意义（t=1.450、1.040，P>0.05）。观察组患者术后排气时间、住院时间分别为（3.06±0.52）、（19.77±4.18）d，对照组患者术后排气时间、住院时间分别为（3.36±0.74）、（21.00±4.51）d；2组患者的术后排气时间、住院时间比较差异无统计学意义（t=1.710、1.004，P>0.05）。 观察组患者发生术后出血1例(2.9%)、吻合口瘘3例(8.6%)、发热5例(14.3%)、切口感染2例(5.7%)；对照组患者发生术后出血5例(21.7%)、吻合口瘘3例(13.0%)、发热4例(17.4%)、切口感染2例(8.7%)； 观察组患者术后出血发生率显著低于对照组（χ2=5.335，P<0.05）；2组患者术后吻合口瘘、发热、切口感染发生率比较差异无统计学意义（χ2=0.299、0.102、0.192，P>0.05）。2组患者术后均随访13个月，观察组患者复发转移2例（5.7%），对照组患者复发转移2例（8.7%）；2组患者复发转移率比较差异无统计学意义（χ2=0.192，P>0.05）。结论　腹腔镜辅助全胃切除术中应用Spiral PDO倒刺线连续全层加固食管-空肠吻合口与3-0可吸收抗菌微乔线间断全层加固食管-空肠吻合口在降低食管-空肠吻合口瘘发生率方面效果相当，Spiral PDO倒刺线连续全层加固吻合口在降低食管-空肠吻合口出血发生率、缩短食管-空肠吻合口加固时间方面更有优势。
Abstract:
Objective　To compare the efficacy and safety of continuous full-thickness reinforcement of the esophagus-jejunal anastomosis with Spiral PDO barbed thread and discontinuous full-thickness reinforcement of the esophagus-jejunal anastomosis with 3-0 absorbable antibacterial microfiber thread in laparoscopic assisted total gastrectomy for gastric cancer.Methods　A total of 58 patients with gastric carcinoma who underwent laparoscopic-assisted total gastrectomy + esophagus-jejunal Roux-en-Y surgery in the Department of General Surgery of the First Affiliated Hospital of Xinxiang Medical University from October 2019 to October 2020 were selected as the research objects.The patients were divided into the observation group (n=35) and the control group (n=23) according to the reinforcement method of esophagojejunal anastomosis.The patients in the observation group were applied with continuous full-thickness reinforcement of the esophagus-jejunal anastomosis with Spiral PDO barbed thread,and the patients in the control group were applied with discontinuous full-thickness reinforcement of the esophagus-jejunal anastomosis with 3-0 absorbable antibacterial microfiber thread.The operation time,esophagojejunostomy reinforcement time,intraoperative blood loss,postoperative exhaust time,hospitalization time and the incidence of complications including postoperative bleeding,anastomotic leakage,fever,incision infection,postoperative anastomotic stenosis of patients were compared between the two groups.Results　The reinforcement time of esophagus-jejunal anastomosis was (6.37±1.69) min,the operation time was (327.00±49.82) min,and the intraoperative blood loss was (99.00±8.90) mL of patients in the observation group;the reinforcement time of esophagus-jejunal anastomosis was (14.95±2.09) min,the operation time was (345.00±32.64) min,and the intraoperative blood loss was (112.90±9.59) mL of patients in the control group;the reinforcement time of esophagus-jejunal anastomosis in the observation group was significantly shorter than that in the control group (t=16.200,P<0.01):there was no significant difference in the operation time and intraoperative blood loss of patients between the two groups (t=1.450,1.040;P>0.05).The postoperative exhaust time and hospitalization time of patients in the observation group were (3.06±0.52) d and (19.77±4.18) d,respectively.The postoperative exhaust time and hospitalization time of patients in the control group were (3.36±0.74) d and (21.00±4.51) d,respectively.There was no significant difference in the postoperative exhaust time and hospitalization time of patients between the two groups (t=1.710,1.004;P>0.05).In the observation group,postoperative bleeding occured in 1 case (2.9%),anastomotic leakage occured in 3 cases (8.6%),fever occured in 5 cases (14.3%),and incision infection occured in 2 cases (5.7%);in the control group,postoperative bleeding occured in 5 cases (21.7%),anastomotic leakage occured in 3 cases (13.0%),fever occured in 4 cases (17.4%),and incision infection occured in 2 cases (8.7%);the incidence of postoperative bleeding of patients in the observation group was significantly lower than that in the control group（χ2=5.335，P<0.05）;there was no significant difference in the incidence of postoperative anastomotic leakage,fever and incision infection of patients between the two groups (χ2=0.299,0.102,0.192;P>0.05).The patients were followed up for 13 months in the two groups;there were 2 cases (5.7%) of recurrence and metastasis in the observation group and 2 cases (8.7%) of recurrence and metastasis in the control group.There was no significant difference in the rate of recurrence and metastasis of patients between the two groups (χ2=0.192,P>0.05).Conclusion　The application of continuous full-thickness reinforcement of the esophagus-jejunal anastomosis with Spiral PDO barbed thread and discontinuous full-thickness reinforcement of the esophagus-jejunal anastomosis with 3-0 absorbable antibacterial microfiber thread in laparoscopic assisted total gastrectomy has the same effect in reducing the incidence of esophagojejunostomy leakage.Continuous full-thickness reinforcement of the esophagus-jejunal anastomosis with Spiral PDO barbed thread has more advantages in reducing the incidence of esophagojejunostomy bleeding and shortening the reinforcement time of esophagus-jejunal anastomosis.

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更新日期/Last Update: 2022-06-05