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.
ZHANG Yin-ke,HAN Xin-ping. Clinical Value of Retropuncture Combined with UN-CUT Anastomosis in Gastrointestinal Reconstruction after Laparoscopic Total Gastrectomy[J]. JOURNAL OF CLINICAL RESEARCH, 2022, 39(9): 1349-1352.
[1] 田晓花,贾海娟.PGR联合血清肿瘤标志物检测在胃良性疾病与胃癌中的鉴别诊断价值[J].医学临床研究,2022,39(4):579-581.
[2] SHEN J,MA X,YANG J,et al.Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer[J].World J Gastrointest Oncol,2020,12(1):21-36.
[3] OJIMA T,NAKAMURA M,YAMAUE H.Full robotic Roux-en-Y reconstruction after gastrectomy for gastric cancer:a loop reconstruction technique[J].Updates Surg,2020,72(4):1279-1281.
[4] 胡凯峰,夏亚斌,许力,等.非离断式Roux-en-Y吻合在腹腔镜远端胃癌根治术中的应用[J].中国微创外科杂志,2019,19(11):1000-1003.
[5] 中华人民共和国国家卫生和计划生育委员会.胃癌规范化诊疗指南(试行)[J].慢性病学杂志,2013,15(10):47-51.
[6] LIU F,HUANG C,XU Z,et al.Morbidity and mortality of laparoscopic vs open total gastrectomy for clinical stage I gastric cancer:The CLASS02 multicenter randomized clinical trial[J].JAMA Oncol,2020,6(10):1590-1597.
[7] CHOI N R,CHOI M H,KO C S,et al.Totally laparoscopic proximal gastrectomy with double tract reconstruction:outcomes of 37 consecutive cases[J].Wideochir Inne Tech Maloinwazyjne,2020,15(3):446-454.
[8] CHYS B,FIERENS J,SOHIER S,et al.Jejuno-Jejunal Intussusception after Roux-en-Y Gastric Bypass[J].Obes Surg,2020,30(10):4155-4158.
[9] 段吉清,张路遥,孙东辉.改良式抵钉座绑线反穿法在结直肠经自然腔道取标本手术消化道重建中的应用[J].中国微创外科杂志,2019,19(1):42-45.
[10] WANG J,WANG Q,DONG J,et al.Total laparoscopic uncut Roux-en-Y for radical distal gastrectomy:an interim analysis of a randomized,controlled,clinical trial[J].Ann Surg Oncol,2021,28(1):90-96.
[11] HANGTIAN C,HUABING H,TIANHANG L,et al.Isoperistaltic versus antiperistaltic uncut Roux-en-Y anastomosis after distal gastrectomy for gastric cancer:a propensity score matched analysis[J].BMC Surg,2020,20(1):274.
[12] SAH B K,LI J,YAN C,et al.Anastomosis for distal gastrectomy in Chinese patients:uncut roux-Y or roux-Y?[J].BMC Surg,2020,20(1):7.
[13] 朱光旭,翟升永,石毅然,等.腹腔镜辅助全胃切除术后非离断Roux-en-Y吻合术的疗效分析[J].中华普通外科杂志,2020,35(8):651-652.
[14] PARK Y S,SHIN D J,SON S Y,et al.Roux stasis syndrome and gastric food stasis after laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction in gastric cancer patients:a propensity score matching analysis[J].World J Surg,2018,42(12):4022-4032.
2022, Vol. 39 
