Poke技术在腹腔镜远端胃癌根治术消化道重建中的应用价值

Clinical study on the application value of the intraluminal Poke technique in digestive tract reconstruction during laparoscopic distal radical gastrectomy

摘要:

目的 探究不同吻合术在腹腔镜远端胃癌根治术消化道重建中的应用价值。方法 回顾性分析2020年1月－2024年12月该院收治的186例远端胃癌患者的临床资料，根据吻合方式不同，将患者分为3组。其中，接受腔内Poke技术行鲁氏Y形（Roux-en-Y）吻合术的59例患者纳入Poke组，接受小切口辅助胃肠Roux-en-Y吻合术的85例患者纳入辅助吻合组，接受全腔镜下直线切割吻合器比尔罗特Ⅱ式（Billroth Ⅱ）吻合术联合布劳（Braun）吻合术的42例患者纳入Billroth Ⅱ式组。比较3组患者手术相关情况、术后并发症、术后半年患者消化道不适症状分级和营养相关指标变化情况。结果 Poke组和Billroth Ⅱ式组吻合时间较辅助吻合组长，差异有统计学意义（P < 0.01）；Poke组和Billroth Ⅱ式组切口总长度短于辅助吻合组，Poke组和Billroth Ⅱ式组术后24和72 h疼痛视觉模拟评分法（VAS）评分低于辅助吻合组，差异均有统计学意义（P < 0.01）。Poke组术后远期并发症总发生率和倾倒综合征发生率低于Billroth Ⅱ式组和辅助吻合组，Billroth Ⅱ式组术后半年消化道不适症状较其他两组严重，差异均有统计学意义（P < 0.0167）。结论 应用Poke技术行Roux-en-Y吻合用于腹腔镜远端胃癌根治术，具有切口小和术后疼痛程度轻等特点，还能降低远期并发症总发生率和倾倒综合征发生率，远期消化道不适症状轻。具有一定的临床应用价值。

Abstract:

Objective To explore the application value of different anastomosis techniques in digestive tract reconstruction during laparoscopic distal radical gastrectomy for distal gastric cancer.Methods A retrospective analysis was conducted on the clinical data of 186 patients with distal gastric cancer treated at our hospital from January 2020 to December 2024. Based on the anastomotic techniques, the patients were divided into three groups. The Poke group (n = 59) consisted of patients who underwent the intracorporeal Poke technique for Roux-en-Y anastomosis. The assistant anastomosis group (n = 85) received mini-incision-assisted Roux-en-Y anastomosis. The Billroth II group (n = 42) underwent totally laparoscopic linear stapler Billroth II anastomosis combined with Braun anastomosis. Perioperative outcomes, postoperative complications, gastrointestinal symptom scores at six months postoperatively, and changes in nutrition-related indicators were compared among the three groups.Results Although the anastomosis time was significantly longer in the Poke and Billroth II groups than in the assistant anastomosis group (P < 0.01), the total incision length in the Poke and Billroth II groups was shorter. Furthermore, the visual analogue scale (VAS) scores at 24 and 72 hours postoperatively were significantly lower in the Poke and Billroth II groups compared to the assistant anastomosis group (P < 0.01). The Poke group had a significantly lower overall incidence of long-term complications and dumping syndrome than both the Billroth II and assistant anastomosis groups. Additionally, the Billroth Ⅱ group experienced more severe gastrointestinal discomfort symptoms at six months postoperatively compared to the other two groups (P < 0.0167).Conclusion Application of the Poke technique for Roux-en-Y anastomosis in laparoscopic distal radical gastrectomy offers advantages such as small incisions and mild postoperative pain. Furthermore, it reduces the overall incidence of long-term complications and dumping syndrome, resulting in milder long-term gastrointestinal symptoms. It possesses certain clinical application value.