根治性远端胃切除术胃-空肠侧侧和端侧吻合临床疗效的对比研究-现代医学

根治性远端胃切除术胃-空肠侧侧和端侧吻合临床疗效的对比研究

单位：1. 东南大学医学院, 江苏南京 210009;
2. 东南大学附属中大医院普外科, 江苏南京 210009

分类号：R615

出版年·卷·期（页码）：2020·39·第七期（809-813）

摘要：

目的：比较开放根治性远端胃切除术胃-空肠侧侧吻合和端侧吻合在胃癌治疗中的临床效果差异。方法：回顾东南大学附属中大医院普外科2013年1月至2019年12月175例行两种术式患者的临床资料，其中端侧吻合组103例，侧侧吻合组72例。比较两组患者手术时间、术中出血量、术后并发症发生率、住院时间、总费用等情况。结果：所有病例均顺利完成了根治性远端胃切除（D2淋巴结廓清术）和消化道重建。两组共26例（15%）患者出现术后胃瘫，其中侧侧吻合组6例（6/72，8%），端侧吻合组20例（20/103，20%），差异有统计学意义（P=0.04）；侧侧吻合组平均住院时间为20 d，端侧吻合组平均住院时间为25 d，差异有统计学意义（P=0.02）。两组患者的一般情况及病史资料，如年龄、性别、体质指数（BMI）等差异无统计学意义（P>0.05）；两组在手术时间、术中出血量、术后吻合口并发症（非胃瘫）、其他并发症以及住院总费用方面，差异均无统计学意义（P>0.05）。结论：胃-空肠侧侧吻合较端侧吻合能降低术后胃瘫的发生风险，并缩短住院时间。

Objective:To compare the clinical effects of open radical gastrectomy for gastric-jejunal side-to-side anastomosis and end-to-side anastomosis in the treatment of gastric cancer. Methods:To review the clinical data of 175 patients who underwent two surgical procedures from January 2013 to December 2019 in Southeast University Affiliated Zhongda Hospital, including 103 cases in end-to-side anastomosis group and 72 cases in side-to-side anastomosis group. The operation time, bleeding volume, postoperative complication rate, hospital stay, and total cost of the two groups were compared.Results: All patients successfully completed radical distal gastrectomy(D2 lymphadenectomy) and gastrointestinal reconstruction. A total of 26 patients(15%) in both groups developed postoperative gastroparesis, 6 patients in the side-to-side anastomosis group(6/72, 8%) and 20 patients in the end-to-side anastomosis group(20/103, 20%), the difference was statistically significant (P=0.04); the median hospital stay in the side-to-side anastomosis group was 20 days, and the median hospital stay in the end-to-side anastomosis group was 25 days, the difference was statistically significant(P=0.01). There was no statistically significant difference between the general condition and medical history of the two groups of patients, such as age, gender, BMI, etc.(P>0.05); the operation time, bleeding volume, postoperative anastomotic complications(non-gastric paralysis), other complications and total hospitalization costs were no statistically significant differences(P>0.05). Conclusion: Gastric-jejunal side-to-side anastomosis can reduce the risk of postoperative gastroparesis and shorten the length of hospitalization. Linear stapler is easy to operate and may reduce anastomosis related complications.

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