全腹腔镜全胃切除术中自牵引后离断食管空肠线性吻合的短中期疗效分析OA
A study on short-to mid-term efficacy of self-pulling and later transection linear esophagojejunal anastomosis in totally laparoscopic total gastrectomy
目的:探讨全腹腔镜全胃切除术中自牵引后离断食管空肠线性吻合的短中期疗效.方法:选取 2020 年 6 月至2024 年6 月收治的90 例行腹腔镜全胃切除术的患者,以术中食管-空肠吻合方式作为分组依据,分为线性组(n=40,采用自牵引后离断食管空肠线性吻合)与圆型组(n=50,采用小切口圆型食管空肠吻合).对比两组手术相关指标、并发症发生率、术后6 个月的营养状态及生命质量.结果:线性组手术时间、食管空肠吻合时间短于圆型组,差异有统计学意义(t=-2.523,Z=-5.691,P<0.05).两组术中出血量、术后首次肛门排气时间、术后住院时间差异无统计学意义(Z=-1.912,t=-0.316,Z=-1.072,P>0.05).线性组与圆型组术后总并发症发生率(10.0%vs.18.0%)、营养状态[血红蛋白(121.35±10.75)g/L vs.(122.54±11.77)g/L,白蛋白(39.55±2.04)g/L vs.(39.16±1.46)g/L,BMI(21.89±1.34)kg/m2 vs.(21.77±1.65)kg/m2]差异无统计学意义(P>0.05).术后6 个月利用欧洲癌症研究与治疗组织生命质量核心问卷-30 量表随访,线性组疼痛症状更轻,差异有统计学意义(Z=-2.268,P<0.05);利用欧洲癌症研究与治疗组织生命质量胃癌特异性问卷-22 量表随访,线性组吞咽困难症状更少、疼痛症状更轻,差异有统计学意义(Z=-3.167,Z=-2.615,P<0.05).结论:全腹腔镜全胃切除术中使用自牵引后离断食管空肠吻合方式可缩短手术时间,提高手术效率及患者生命质量,且不会增加手术并发症,值得临床推广.
Objective:To investigate the short-to mid-term efficacy of self-pulling and later transection linear esophagojejunal anastomosis in totally laparoscopic total gastrectomy.Methods:Ninety patients who underwent laparoscopic total gastrectomy between Jun.2020 and Jun.2024 were selected.According to the intraoperative esophagojejunal anastomosis method,patients were divided into the linear group(n=40,treated with self-pulling and later transection linear esophagojejunal anastomosis),and the circular group(n=50,treated with mini-laparotomy circular esophagojejunal anastomosis).Operative related parameters,complication rate,nutritional sta-tus,and quality of life at 6 months after operation were compared between the two groups.Results:The operation time and esophagojeju-nal anastomosis time in the linear group were shorter than those in the circular group,and the differences were statistically significant(t=-2.523,Z=-5.691,P<0.05).There were no statistically significant differences between the two groups in intraoperative blood loss,time to first postoperative anal flatus,and postoperative hospital stay(Z=-1.912,t=-0.316,Z=-1.072,P>0.05).There were no sta-tistically significant differences in the total postoperative complication rate(10.0%vs.18.0%)and nutritional status[hemoglobin(121.35±10.75)g/L vs.(122.54±11.77)g/L,albumin(39.55±2.04)g/L vs.(39.16±1.46)g/L,BMI(21.89±1.34)kg/m2 vs.(21.77±1.65)kg/m2]between the linear group and the circular group(P>0.05).At6 months after operation,follow-up using the European organization for research and treatment of cancer quality of life questionnaire-core 30 showed that the pain symptoms in the linear group were milder,and the difference was statistically significant(Z=-2.268,P<0.05);follow-up using the European organiza-tion for research and treatment of cancer quality of life gastric cancer-specific questionnaire-22 showed that the linear group had fewer dysphagia symptoms and milder pain symptoms,and the differences were statistically significant(Z=-3.167,Z=-2.615,P<0.05).Conclusions:The use of self-pulling and later transection linear esophagojejunal anastomosis in totally laparoscopic total gastrectomy can shorten operative time,improve the operation efficiency and the patient's quality of life,without increasing surgical complications,which is worthy of clinical promotion.
陈爱山;沈加成;周磊;苗志龙;蒿汉坤
南通大学第六附属医院(盐城市第三人民医院)普通外科,江苏 盐城,224000南通大学第六附属医院(盐城市第三人民医院)普通外科,江苏 盐城,224000南通大学第六附属医院(盐城市第三人民医院)普通外科,江苏 盐城,224000南通大学第六附属医院(盐城市第三人民医院)普通外科,江苏 盐城,224000复旦大学附属华山医院普通外科
医药卫生
全胃切除术腹腔镜检查自牵引后离断食管空肠吻合线性吻合圆型吻合并发症
Total gastrectomyLaparoscopySelf-pulling latter transection esophagojejunal anastomosisLinear anastomosisCircular anastomosisComplications
《腹腔镜外科杂志》 2026 (1)
51-57,7
江苏医药职业学院校地协同创新研究项目(20229121)
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