捆绑式反穿刺法食管空肠吻合技术在腹腔镜胃癌根治术中的应用
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樊林, Email: linnet@mail.xjtu.edu.cn

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陕西省重点研究发展基金资助项目(2018SF-044)。


Application of tied reverse puncture esophagojejunostomy in laparoscopic radical gastrectomy for gastric cancer
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    摘要:

    目的:探讨捆绑式反穿刺法食管空肠吻合技术在腹腔镜根治性全胃切除术中的应用效果。
    方法:回顾分析2014年6月—2018年6月92例行腹腔镜根治性全胃切除术患者的临床资料,其中46例术中采用捆绑式反穿刺法进行食管-空肠吻合(观察组),46例采用荷包钳法进行食管-空肠吻合(对照组)。比较两组患者的相关临床指标。
    结果:全部患者均顺利完成手术。与对照组比较,观察组手术时间缩短(229.2 min vs. 196.2 min)、术中出血量减少(83.26 mL vs. 56.18 mL)、切口长度缩短(9.08 cm vs. 3.89 cm)、食管近切缘长度增长(2.42 cm vs. 3.78 cm)、自抵钉座置入至食管空肠吻合完成时间缩短(32.1 min vs. 19.2 min),差异均有统计学意义(均P<0.05)。两组术后首次排气时间、住院时间均无统计学差异(均P>0.05)。两组吻合口出血、切口感染、吻合口狭窄发生率均无统计学差异(均P>0.05),但观察组吻合口瘘发生率低于对照组(0 vs. 6.52%,P<0.05)。两组术后随访6~30个月,对照组复发2例,观察组未发现复发病例。
    结论:捆绑式反穿刺吻合技术应用于腹腔镜根治性全胃切除术中是安全、可行的,具有手术时间短、术中出血少等优点,以及可减小腹壁辅助切口、获得更大的切缘、降低吻合口瘘及复发风险等优越性。

    Abstract:

    Objective: To investigate the application efficacy of esophagojejunostomy using the tied reverse puncture in laparoscopic radical total gastrectomy. 
    Methods: The clinical data of 92 patients undergoing laparoscopic radical total gastrectomy from June 2014 to June 2018 were retrospectively analyzed. Of the patients, 46 cases underwent esophago-jejunal anastomosis using the tied reverse puncture (observation group), and the other 46 cases underwent esophago-jejunal anastomosis using the purse-string suture (control group). The main clinical variables between the two groups of patients were compared.
    Results: Operations in all patients were completed uneventfully. In observation group compared with control group, the operative time was shortened (229.2 min vs. 196.2 min), the intraoperative blood loss was decreased (83.26 mL vs. 56.18 mL), the length of incision was reduced (9.08 cm vs. 3.89 cm), the proximal cut edge of the esophagus was longer (2.42 cm vs. 3.78 cm), and the time from placement of the nail anvil to completion of esophagojejunostomy was shortened (32.1 min vs. 19.2 min), and all the differences had statistical significance (all P<0.05). There were no significant differences in the time to first postoperative gas passage and length of hospital stay between the two groups (both P>0.05). No significant differences were noted in incidence of anastomotic bleeding, wound infection and anastomotic stenosis between the two groups (all P>0.05), but the incidence of anastomotic leakage in observation group was significantly lower than that in control group (0 vs. 6.52%, P<0.05). Patients in both groups were followed up for 6 to 30 months, and recurrence occurred in 2 cases in control group, but no recurrence was found in observation group.
    Conclusion: Application of the tied reverse puncture esophagojejunostomy in laparoscopic radical total gastrectomy is safe and feasible. It also has the advantages of short operative time and less bleeding, and the superiorities of reducing the size of the auxiliary incision of the abdominal wall, obtaining longer cut margin, and decreasing the risk of anastomotic leakage and recurrence.

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李胜, 杨文光, 樊林.捆绑式反穿刺法食管空肠吻合技术在腹腔镜胃癌根治术中的应用[J].中国普通外科杂志,2019,28(10):1197-1204.
DOI:10.7659/j. issn.1005-6947.2019.10.006

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  • 收稿日期:2019-01-04
  • 最后修改日期:2019-09-14
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  • 在线发布日期: 2019-10-25