腹腔镜全胃切除术后实施改良自牵引后离断食管空肠腔内吻合对胃癌患者的近远期应用效果分析

doi:10.3969/j.issn.1006-6233.2022.08.017

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摘要 目的: 探讨改良自牵引后离断食管空肠腔内吻合对腹腔镜全胃切除术胃癌患者的近远期临床效果。方法: 选择2020年1月至2021年2月期间96例胃癌患者,采用随机数字表法将所有患者简单随机分组为传统组48例和改良组48例,传统组患者采用传统Overlap,对照组采用改良自牵引后离断食管空肠腔内吻合。记录两组患者的术中及术后恢复情况。对比两组患者术前及术后1年的营养状态和生活质量。记录两组患者术后并发症发生情况。结果: 传统组手术时间及食管空肠吻合时间显著高于改良组,差异具有统计学意义(P<0.05),但两组患者术中出血量、淋巴结清扫数、术后首次肛门排气时间、住院时间均无显著性差异(P>0.05);两组患者术前的营养水平各指标比较,差异均无统计学意义(P>0.05),术后一年两组患者的体重、白蛋白、预后营养指数均显著高于术前,两组患者术后一年的体重、白蛋白、预后营养指数及各指标增加差值均无显著性差异(P>0.05);术后一年两组患者的生活质量显著优于术前,同时两组患者术后一年生活质量评分、评分增加差值、术后并发症发生率比较差异均无统计学意义(P>0.05)。结论: 改良自牵引后离断食管空肠腔内吻合是一种安全可靠的吻合方式,能显著缩短手术时间,改善患者术后营养状态和生活质量,近远期疗效满意。

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	赵军抗
	张前进

关键词 ：腹腔镜全胃切除术, 胃癌, 食管空肠吻合术, 自牵引后离断, 营养状态, 生活质量

Abstract：Objective: To investigate the short-term and long-term clinical effect of modified self traction transection esophagojejunostomy in patients with gastric cancer after laparoscopic total gastrectomy.Methods: 96 patients with gastric cancer from January 2020 to February 2021 were randomly divided into 48 patients in the traditional group and 48 patients in the improved group. Patients in the traditional group were treated with traditional Overlap, and patients in the control group were treated with modified self traction and transection of esophagojejunostomy. The intraoperative and postoperative recovery of the two groups were recorded. The nutritional status and quality of life of the two groups were compared before and 1 year after the operation. The postoperative complications of the two groups were recorded. Result: The operation time and esophagojejunostomy time in the traditional group were significantly higher than those in the improved group (P<0.05), but there was no significant difference in intraoperative bleeding, lymph node dissection, first postoperative anal exhaust time, and hospital stay between the two groups (P>0.05); there was no significant difference in preoperative nutritional level between the two groups (P>0.05). The body weight, albumin, and prognostic nutritional index of the two groups one year after the operation were significantly higher than those before the operation. There was no significant difference in body weight, albumin, prognostic nutritional index, and the increase difference of each index between the two groups one year after operation (P>0.05). One year after the operation, the quality of life of the two groups was significantly better than that before the operation. At the same time, there was no significant difference between the two groups in the score one year after the operation, the difference in score increase, and the incidence of postoperative complications (P>0.05).Conclusion: Modified self-traction transected esophagojejunostomy is a safe and reliable anastomosis method, which significantly shortens the operation time, improves the postoperative nutritional status and quality of life of patients, and the short-term and long-term curative effect is satisfactory.

Key words： Laparoscopic total gastrectomy Gastric cancer Esophagojejunostomy Disconnect after self traction Nutritional status Quality of life

基金资助:江苏省科技项目,(编号:BK20191077)

通讯作者: 张前进

引用本文:

赵军抗, 张前进. 腹腔镜全胃切除术后实施改良自牵引后离断食管空肠腔内吻合对胃癌患者的近远期应用效果分析[J]. 河北医学, 2022, 28(8): 1316-1320.
ZHAO Junkang, ZHANG Qianjin. Analysis of Short-Term and Long-Term Effect of Modified Self-Traction Post-Dissection Esophageal-Jejunostomy after Laparoscopic Total Gastrectomy in Patients with Gastric Cancer. HeBei Med, 2022, 28(8): 1316-1320.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.08.017 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I8/1316

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