反穿刺结合UN-CUT吻合在腹腔镜下全胃切除术消化道重建中的应用价值

doi:10.3969/j.issn.1671-7171.2022.09.019

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摘要【目的】探讨反穿刺结合UN-CUT吻合在胃癌腹腔镜下全胃切除术消化道重建术中的应用价值。【方法】选取2018年9月至2021年1月二院收治的138例行腹腔镜全胃切除术的患者,根据消化道重建吻合方式的不同将患者分为反穿刺组(行反穿刺结合UN-CUT吻合术)和Roux-en-Y组(行Roux-en-Y吻合术),每组69例。比较两组手术相关指标,术后近期并发症、营养指标变化以及随访结果。【结果】两组手术时间、消化道重建时间、淋巴结清扫数目、首次流质饮食时间、引流管拔除时间、住院时间比较,差异均无统计学意义(P>0.05);反穿刺组切口长度、肛门首次排气时间、术中出血量均少于Roux-en-Y组,差异有统计学意义(P<0.05)。两组术后1、3个月体重降低情况及术后1个月白蛋白(ALB)、血红蛋白(HGB)降低情况比较,差异均无统计学意义(P>0.05);反穿刺组术后3个月ALB、HGB降低量小于Roux-en-Y组,差异有统计学意义(P<0.05)。反穿刺组术后食物排空障碍、肠梗阻均为1例,Roux-en-Y组分别为5例、3例,两组比较,差异均无统计学意义(P>0.05)。术后均随访3个月,反穿刺组反流性食管炎、Roux综合征发生率均低于Roux-en-Y组(P<0.05)。【结论】反穿刺结合UN-CUT吻合具有保持肠道连续性的优势,可缩短手术切口,降低术后反流性食管炎及Roux综合征发生率,改善患者营养状态,可应用于临床。

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	张银科
	韩新平

关键词 ：胃肿瘤/外科学, 腹腔镜检查, 胃切除术, 吻合术,Roux-en-Y

Abstract：【Objective】 To investigate the clinical value of retropuncture combined with UN-CUT anastomosis in gastrointestinal reconstruction after laparoscopic total gastrectomy for gastric cancer.【Methods】A total of 138 patients with laparoscopic total gastrectomy admitted to our hospital from September 2018 to January 2021 were selected and divided into reverse puncture group (reverse puncture combined with UN-CUT anastomosis) and Roux-en-Y group according to different ways of digestive tract reconstruction and anastomosis, with 69 patients in each group. The postoperative complications, nutritional changes and follow-up results were compared between the two groups.【Results】There was no significant difference between the two groups in operation time, digestive tract reconstruction time, number of lymph nodes cleared, first liquid diet time, drainage tube removal time, and hospital stay (P>0.05); The incision length, the time of the first anal exhaust, and the amount of bleeding in the reverse puncture group were lower than those in the Roux-en-Y group, with significant differences (P<0.05). There was no significant difference between the two groups in terms of weight loss 1 and 3 months after operation and the reduction of ALB and HGB 1 month after operation (P>0.05); The decrease of ALB and HGB in the reverse puncture group was less than that in the Roux-en-Y group 3 months after operation, and the difference was statistically significant (P<0.05). There were 1 case of food loop emptying disorder and intestinal obstruction in the reverse puncture group, and 5 cases and 3 cases in the Roux-en-Y group respectively,without significant difference between the two groups (P>0.05). All patients were followed up for 3 months. The incidence of reflux esophagitis and Roux syndrome in the reverse puncture group was lower than that in Roux-en-Y group (P<0.05). 【Conclusion】 Reverse puncture combined with UN-CUT anastomosis has the advantages of maintaining intestinal continuity, shortening the surgical incision, reducing the incidence of postoperative reflux esophagitis and Roux syndrome, and improving the nutritional status of patients, which can be applied in clinical practice.

Key words： Stomach Neoplasms/SU Laparoscopy Gastrectomy Anastomosis,Roux-en-Y

收稿日期: 2021-10-19

中图分类号:

R735.2

通讯作者: *E-mail:849791193@qq.com

引用本文:

张银科, 韩新平. 反穿刺结合UN-CUT吻合在腹腔镜下全胃切除术消化道重建中的应用价值[J]. 医学临床研究, 2022, 39(9): 1349-1352.
ZHANG Yin-ke, HAN Xin-ping. Clinical Value of Retropuncture Combined with UN-CUT Anastomosis in Gastrointestinal Reconstruction after Laparoscopic Total Gastrectomy. JOURNAL OF CLINICAL RESEARCH, 2022, 39(9): 1349-1352.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2022.09.019 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2022/V39/I9/1349

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