張灼新+吳祖光+李恩

[摘要] 目的 探討腹腔鏡遠(yuǎn)端胃癌根治術(shù)胃空腸Uncut Roux-en-Y吻合的安全性和可行性。方法 回顧性分析我院實(shí)施的20例全腹腔鏡遠(yuǎn)端胃癌根治術(shù)胃空腸Uncut Roux-en-Y吻合患者的臨床資料，并選擇20例腹腔鏡輔助遠(yuǎn)端胃癌根治術(shù)胃空腸Uncut Roux-en-Y吻合患者作為對(duì)照組，對(duì)兩組患者手術(shù)指標(biāo)和臨床療效進(jìn)行對(duì)比分析。 結(jié)果 本次研究納入的40例患者均手術(shù)成功。兩組患者手術(shù)情況之間比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。兩組術(shù)后病理分期比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。兩組患者術(shù)后并發(fā)癥比較顯示，觀察組吻合口出血、Roux 滯留綜合征、反流性食管炎和殘胃炎發(fā)生例數(shù)少于對(duì)照組，總并發(fā)癥發(fā)生率低于對(duì)照組（P<0.05）。 結(jié)論 腹腔鏡下uncut Roux-en-Y吻合在遠(yuǎn)端胃癌根治術(shù)中是安全、可行的，具有良好的臨床應(yīng)用價(jià)值。

[關(guān)鍵詞] 腹腔鏡；Uncut Roux-en-Y吻合；遠(yuǎn)端胃癌根治術(shù)

[中圖分類(lèi)號(hào)] R735.2 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 2095-0616（2017）13-174-04

[Abstract] Objective To explore the feasibility and safety of laparoscopic uncut Roux-en-Y anastomosis in distal gastectomy. Methods The clinical data of 20 in-hospital cases with laparoscopic Uncut Roux-en-Y anastomosis in distal gastectomy were retrospectively analyzedis.And 20 cases of laparoscopic assisted distal gastric cancer treated with Uncut Roux-en-Y anastomosis were chosen as the control group.The surgical indexes and clinical curative effects of the two groups were compared. Results All patients underwent successful operation.There was no significant difference between the operation index of the two group（P>0.05）.The results of postoperative pathological staging showed that there were no significant differences between the two groups（P>0.05）.Compared with the control group，the number of cases of anastomotic bleeding，Roux retention syndrome，reflux esophagitis and residual gastritis were less than those in the control group，and the total complications of treatment group was lower than that of the control group（P<0.05）. Conclusion Laparoscopic Uncut Roux-en-Y anastomosis in distal gastectomy is safe and feasible.It should be extended in clinic.

[Key words] Laparoscopic；Uncut Roux-en-Y anastomosis；Distal gastectomy

隨著腹腔鏡技術(shù)經(jīng)驗(yàn)的積累及器械的發(fā)展，腹腔鏡胃癌手術(shù)已實(shí)現(xiàn)規(guī)范化的淋巴結(jié)清掃，并呈現(xiàn)出取代傳統(tǒng)開(kāi)腹手術(shù)的趨勢(shì)。消化道重建是腹腔鏡胃癌手術(shù)的主要難點(diǎn)之一，尤其是全腹腔鏡下的消化道重建難度更大[1]。理想的消化道重建不僅能夠保障手術(shù)本身的安全性，更能夠保證胃癌患者術(shù)后的營(yíng)養(yǎng)需要和生存質(zhì)量[2]。全腹腔鏡遠(yuǎn)端胃癌根治術(shù)消化道重建方式主要有Billroth-Ⅰ、Billroth-Ⅱ及Roux-en-Y 吻合3種[3]。Billroth-Ⅰ、Billroth-Ⅱ兩種重建方式操作相對(duì)簡(jiǎn)單，但均具有其明顯的缺陷。Roux-en-Y 吻合包括傳統(tǒng) Roux-en-Y 吻合和非離斷式（Uncut）Roux-en-Y 吻合，操作相對(duì)復(fù)雜，但相對(duì)適應(yīng)證廣，更符合人體生理，可有效提高患者術(shù)后的生活質(zhì)量[4-5]。而Uncut Roux-en-Y吻合適用范圍更廣，且明顯減少了傳統(tǒng)Roux-en-Y 吻合的 Roux 滯留綜合征發(fā)生率。本文通過(guò)回顧性分析我院實(shí)施的20例全腹腔鏡遠(yuǎn)端胃癌根治術(shù)胃空腸Uncut Roux-en-Y吻合患者的臨床資料，旨在探討其安全性和可行性。

1 資料與方法

1.1 一般資料

選擇我院2015年1月～2017年4月收治的行根治性胃遠(yuǎn)端切除+全腹腔鏡消化道重建患者20例，作為觀察組，其中男12例，女8例，年齡44～79歲，平均（59.3±11.4）歲。并選擇同時(shí)期行腹腔鏡輔助遠(yuǎn)端胃癌根治術(shù)胃空腸Uncut Roux-en-Y吻合患者20例作為對(duì)照組，男13例，女7例，年齡44～80歲，平均（59.8±10.5）歲。所有40例入選患者均經(jīng)術(shù)前胃鏡及活檢組織病理學(xué)檢查證實(shí)為腺癌，腫瘤位于胃角22例、胃體9例、胃竇9例。術(shù)前常規(guī)通過(guò)胃鏡確定腫瘤病灶上緣距離賁門(mén)的距離，行CT檢查進(jìn)行術(shù)前分期，評(píng)估臨床TNM分期。