直线切割吻合器在腹腔镜辅助远端胃癌根治术Roux-en-Y式吻合术中的应用

Application of linear cutting stapler in Roux-en-Y anastomosis assisted laparoscopic radical gastrectomy for distal gastric cancer

摘要:

目的 探讨直线切割吻合器在腹腔镜辅助远端胃癌根治术（LDG）Roux-en-Y式吻合术中的应用效果。方法 选取2019年3月－2021年3月该院行LDG Roux-en-Y式吻合术的患者126例，按照随机数表法分为观察组（n = 63）和对照组（n = 63），观察组采用直线切割吻合器实施Roux-en-Y式吻合术，对照组采用圆形吻合器实施Roux-en-Y式吻合术。统计并分析两组患者手术时间、术中出血量、清扫淋巴结数量、阳性淋巴结数量、术后恢复排气时间、首次进流食时间、拔除引流管时间和术后并发症发生率，术后3个月采用健康调查量表36（SF-36）比较两组患者的生活质量。结果 两组患者手术时间、术中出血量、清扫淋巴结数量和阳性淋巴结数量比较，差异均无统计学意义（P > 0.05）；与对照组比较，观察组术后恢复排气时间、首次进流食时间和拔除引流管时间均较短（P < 0.05）；两组患者住院总费用比较，差异无统计学意义（P > 0.05），观察组术后住院时间明显短于对照组（P < 0.05）；与对照组比较，观察组并发症发生率更低（P < 0.05）；术后3个月随访，观察组SF-36评分明显高于对照组（P < 0.05）。结论 与圆形吻合器相比，直线切割吻合器应用于LDG Roux-en-Y式吻合术中，能够有效提高术中和术后安全性，促进患者术后恢复，改善患者术后生活质量。

Abstract:

Objective To explore the application effect of linear cutting stapler in Roux-en-Y anastomosis assisted laparoscopic distal gastrectomy (LDG).Methods 126 patients underwent Roux-en-Y anastomosis after LDG were enrolled between March 2019 and March 2021. They were divided into observation group (n = 63) and control group (n = 63) by simple random grouping method. The observation group underwent Roux-en-Y anastomosis with linear cutting stapler, while control group underwent Roux-en-Y anastomosis with circular stapler. The operation time, intraoperative blood loss, number of lymph node dissection and positive lymph nodes, postoperative first exhaust time, the first time to eating fluid liquid food, extubation time of drainage tube and occurrence of postoperative complications in the two groups were compared. While 3 months after surgery, quality of life in both groups were followed up by short form 36 (SF-36) health survey questionnaire.Results The operative time, intraoperative blood loss, number of dissected lymph nodes and number of positive lymph nodes in observation group have no differences with those in control group (P > 0.05). The time of postoperative recovery of exhaust, first liquid feeding and drainage tube removal in observation group were significantly shorter than those in control group (P < 0.05). There was no significant difference in total hospitalization cost between the two groups (P > 0.05). The postoperative hospitalization time in observation group was significantly shorter than that in control group (P < 0.05), and incidence of postoperative complications was lower than that in control group (P < 0.05). After 3 months of postoperative follow-up, SF-36 scale in observation group was higher than that in control group (P < 0.05).Conclusion Compared to the circular stapler, the application of linear cutting stapler in Roux-en-Y anastomosis can effectively improve the safety of the operation and the postoperative safety, shorten the postoperative recovery time and improve the postoperative quality of life of patients.