食物袢与十二指肠残端固定技术在远端胃癌Roux-en-Y重建术中的临床疗效分析OA

Objective:To investigate the efficacy,clinical characteristics and advantages of the fixation technique of food loop and duodenal stump in Roux-en-Y reconstruction after radical distal gastrectomy for gastric cancer.Methods:A retrospective analysis was conducted on clinical data of patients who underwent radical distal gastrectomy combined with Roux-en-Y reconstruction between Jan.1,2018 and Oct.31,2024.According to whether the intraoperative fixation of food loop and duodenal stump was performed,patients were divided into fixation group and non-fixation group.After propensity score matching,62 pairs of patients were finally enrolled after propensity score matching.The operative time,intraoperative blood loss and incidence of postoperative complications,especially the inci-dence of Roux-en-Y stasis syndrome,were compared between the two groups.Univariate and multivariate logistic regression analyses were performed to screen the independent risk factors for postoperative complications.A predictive model was constructed based on the above factors.The discriminative ability of the model was evaluated by calculating the area under the receiver operating characteristic curve.The goodness of fit and clinical application value of the model were comprehensively assessed via calibration curve and decision curve analysis.Results:All operations were performed successfully.There were no statistically significant differences between the two groups in terms of intraoperative blood loss,operative time,time to first postoperative anal flatus,intraoperative blood transfusion,hospi-tal stay,total incidence of postoperative complications and incidence of duodenal stump leakage(P>0.05).The incidence of Roux-en-Y stasis syndrome in the fixation group was significantly lower than that in the non-fixation group(P<0.05).Logistic regression analysis indicated that duodenal stump fixation was not an independent risk factor for postoperative complications.Age≥60 years,combined dia-betes mellitus and preoperative hypoalbuminemia were independent risk factors for postoperative complications,while laparoscopic sur-gery was a protective factor.The nomogram predictive model constructed based on the above variables showed good discrimination,with an area under the receiver operating characteristic curve of 0.832.The calibration curve showed a high consistency between predicted risk and actual observed risk(Hosmer-Lemeshow test:χ2=14.09,P=0.119).Decision curve analysis verified that the model presented significant net benefit in clinical application.Conclusions:Fixation of food loop and duodenal stump can reduce the incidence of Roux-en-Y stasis syndrome after radical distal gastrectomy.This technique has the advantages of simple operation,stable process,high safety and definite efficacy,which is worthy of clinical promotion.