不同吻合方法应用于腹腔镜全胃切除术食管空肠吻合重建中的对比研究

Comparative study of different anastomosis methods in laparoscopic total gastrectomy esophagus jejunum anastomosis reconstruction

摘要:

目的 探讨π形吻合与圆形吻合（反穿刺法）在腹腔镜全胃切除术后食管-空肠吻合重建中的安全性和短期疗效。方法 采取回顾性研究，收集2019年1月－2021年3月该院收治的75例胃癌患者的临床资料，按食管-空肠吻合方法不同，分为直线型切割闭合器吻合组（π形吻合组，27例）和圆形吻合器吻合组（反穿刺法组，48例）。比较两组患者全腹腔镜下重建食管空肠吻合的时间、手术时间、术中出血量、淋巴结清扫总数、术中及术后并发症的发生情况。结果 π形吻合组手术时间和食管空肠吻合时间分别为：（221.5±8.8）和（34.7±3.7）min，与反穿刺法组的（246.9±5.6）和（47.2±4.6）min比较，差异均有统计学意义（t = 15.19，t = 11.81，P < 0.05）。两组患者术中出血量和术中淋巴结清扫总数比较，差异均无统计学意义（P > 0.05）。反穿刺法组发生术中并发症2例，包括：食管空肠吻合口闭锁1例，吻合口撕裂1例；发生术后并发症3例，包括：吻合口狭窄2例，吻合口出血1例。结论 全腹腔镜下食管-空肠π形吻合和反穿刺法吻合均是安全、可行的，在食管空肠吻合时间方面，π形吻合重建时间更短。当小肠直径较细，伸入25 mm吻合器较为困难时，π形吻合优势较为明显。肿瘤浸润至齿状线以上的Siewert Ⅰ型和Ⅱ型食管胃结合部腺癌，推荐反穿刺法，使用管状吻合器进行重建。

Abstract:

Objective To investigate the safety and short-term efficacy of π-shaped anastomosis and circular anastomosis (reverse puncture device) in reconstruction of esophagojejunostomy after laparoscopic total gastrectomy.Methods A retrospective study was used to collect the clinical and pathological data of 75 cases of gastric cancer from January 2019 to March 2021. According to the different reconstruction methods of esophagojejunal anastomosis, the patients were divided into a linear cutting obturator group (π-shaped anastomosis group, n = 27) and a circular anastomat anastomosis group (reverse puncture device group, n = 48). The general information of the two groups, operation time, esophagojejunostomy time, intraoperative bleeding volume, number of intraoperative lymph node dissection, intraoperative complications, and postoperative complications were compared and analyzed.Results The operation time and esophagojejunostomy time in the π-shaped anastomosis group were (221.5 ± 8.8) and (34.7 ± 3.7) min, and the reverse puncture device group were and (246.9 ± 5.6) and (47.2 ± 4.6)min, respectively, the differences were statistically significant (t = 15.19, t = 11.81, P < 0.05). There were no statistical significance in the comparison of intraoperative bleeding volume and number of intraoperative lymph node dissection between the two groups (P > 0.05). In the reverse puncture device group, there were two intraoperative complications, including one case of esophageal jejunal anastomosis atresia and one case of anastomosis tear, postoperative complications occurred in 3 cases, postoperative anastomotic stenosis occurred in 2 case, and anastomotic bleeding occurred in 1 case.Conclusion Laparoscopic total esophagojejunostomy with π-shaped anastomosis and reverse puncture device are safe and feasible. In terms of esophagojejunostomy time, π-shaped anastomosis reconstruction time is shorter. When the small intestine diameter is relatively small and it is difficult to extend into the 25 mm stapler, the advantage of π-shaped anastomosis is more obvious. When the tumor is Siewert type Ⅰ and type Ⅱ adenocarcinoma of gastroesophageal junction, which infiltrates into above the dentate line, reverse puncture device method is recommended for reconstruction.