近端胃切除食管空肠π型吻合与圆形吻合的安全性及短期疗效对比

汪明庆; 盛伟伟; 曹国栋; 夏国志; 耿奇龙; 熊茂明; 胡孔旺

doi:10.16766/j.cnki.issn.1674-4152.003832

近端胃切除食管空肠π型吻合与圆形吻合的安全性及短期疗效对比

doi: 10.16766/j.cnki.issn.1674-4152.003832

1.
安徽医科大学第一附属医院普外科，安徽合肥 230000
2.
安徽医科大学附属阜阳医院普外科，安徽阜阳 236000
3.
安徽医科大学临床医学系，安徽合肥 230032

基金项目:

安徽省转化医学研究院科研基金项目 2023zhyx-B19

安徽医科大学质量工程项目 2021xjjyxm34

安徽省省级质量工程项目 2020xsxxkc247

国家级大学生创新创业训练计划项目 202210366008

详细信息

通讯作者:
胡孔旺，E-mail：hukw@sina.com

中图分类号: R735.2 R730.56
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- 文章访问数: 28
- HTML全文浏览量: 15
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-04-18
- 网络出版日期: 2025-02-13

Analysis of the safety and efficacy of proximal gastrectomy of esophageal-jejunal π-type anastomosis and circular anastomosis

1.
Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, China

摘要

摘要: 目的比较近端胃切除术中全腔镜食管空肠改良π型吻合与开放圆形吻合2种不同消化道重建方式的围手术期情况及术后疗效，探讨改良π型吻合技术联合双通道吻合技术在近端胃切除术中的安全性及有效性。方法回顾性分析2018年1月—2023年1月于安徽医科大学第一附属医院胃肠外科行腹腔镜或开放近端胃切除、双通道吻合消化道重建的63例胃癌患者临床资料，其中开放食管空肠圆形吻合24例(圆吻组)，全腔镜下食管空肠改良π型吻合39例(π吻合组)。比较2组患者的临床资料、围手术期恢复情况及术后并发症等相关指标，评价改良π型吻合技术的安全性和疗效。结果 2组术前基线资料、术中清扫的淋巴结数目、切缘情况、术中出血量、手术时间及吻合时间、术后相关并发症等比较差异均无统计学意义(P>0.05)，而切口长度[(4.92±0.53)cm vs. (14.33±1.80)cm，P < 0.001]、首次下地活动时间[(1.07±0.27)d vs. (1.91±0.58)d，P < 0.001]、首次排气时间[(2.17±0.38)d vs.(2.91±0.58)d, t=4.652, P=0.039]、恢复全流食时间、术后住院时间、术后第3天NRS评分、切口感染、术后并发症分级整体情况等差异均有统计学意义(P < 0.05)。结论近端胃切除双通道消化道重建中联合食管空肠π型吻合和开放圆形吻合同样安全有效，且π型吻合创伤小、恢复快，是一种安全可行、值得去尝试的消化道重建策略。
- 胃癌 /
- 近端胃切除术 /
- 双通道消化道重建术 /
- 食管空肠π型吻合术 /
- 食管空肠圆形吻合
Abstract: Objective Compare the perioperative and postoperative outcomes of two different digestive reconstructions: improved endoscopic esophago-jejunal π-anastomosis and open circular anastomosis in proximal gastrectomy. We investigated the safety and effectiveness of improved π-anastomosis combined with dual channel anastomosis in proximal gastrectomy. Methods A retrospective analysis was conducted on the clinical data of 63 cases of gastric cancer who underwent laparoscopic or open proximal gastrectomy, dual-channel anastomosis in the Department of Gastroenterology at the First Affiliated Hospital of Anhui Medical University from January 2018 to January 2023. Among them, 24 cases underwent open esophagojejunal circular anastomosis (circular anastomosis group); 39 cases of full endoscopic esophagojejunal modified π-type anastomosis were selected (π anastomosis group). Compare the clinical data, perioperative recovery, and postoperative complications of two groups of patients to evaluate the safety and efficacy of the improved π-type anastomosis technique. Results There were no differences between the π-type anastomosis group and the round astomosis group in terms of preoperative baseline data, number of lymph nodes dissected during operation, cutting edge condition, intraoperative blood loss, operation time and anastomosis time, and postoperative related complication (P>0.05), but the length of the incision [(4.92±0.53) cm vs. (14.33±1.80) cm, P < 0.001], the time of the first activity on the ground [(1.07±0.27) d vs. (1.91±0.58) d, P < 0.001], first exhaust time [(2.17±0.38) d vs. (2.91±0.58) d, t=4.652, P=0.039], the time to return to a full liquid diet, the length of postoperative hospital stay, NRS score on the third postoperative day, the incision infection, and overall postoperative complication grading, these were significant statistical differences (P < 0.05). Conclusion The combined esophageal-jejuno-π anastomosis and open circular anastomosis in the double-channel gastrointestinal reconstruction of proximal gastrectomy are equally safe and effective, while the π-type anastomosis is less invasive and has a faster recovery, which is a safe, feasible and worthwhile strategy for gastrointestinal reconstruction.
- Gastric cancer /
- Proximal gastrectomy /
- Dual channel gastrointestinal reconstruction /
- Esophagojejunal π-type anastomosis /
- Esophagojejunal circular anastomosis

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图 1 全腔镜下食管空肠π型吻合联合双通道吻合过程

注：A为牵拉食道；B为裁剪小肠系膜；C为食管空肠π型吻合；D为三合一关闭共同开口；E为闭合后效果展示；F为残胃空肠侧侧吻合术；G为缝线关闭共同开口；H为小肠侧侧吻合术；I为关闭小肠共同开口。

Figure 1. The process of total endoscopic oesophagojejunal π anastomosis combined with bichannel anastomosis

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表 1 2组胃癌患者基线资料比较

Table 1. Comparison of baseline data between two groups of gastric cancer patients

项目	圆吻组(n=24)	π吻合组(n=39)	统计量	P值
性别(男/女，例)	17/7	30/9	0.291^a	0.590
年龄(x±s, 岁)	67.96±7.89	64.46±8.60	1.617^b	0.111
BMI(x±s)	23.23±2.91	22.92±3.06	0.399^b	0.691
基础疾病(例)	9	11	0.592^a	0.441
既往史(例)
吸烟史	8	12	0.045^a	0.832
饮酒史	7	13	0.119^a	0.730
肿瘤部位的分型AEG(例)			1.958^a	0.162
Siewert Ⅰ型	0	0
Siewert Ⅱ型	24	37
Siewert Ⅲ型及胃体、胃底癌	0	2
肿瘤最大直径(x±s，cm)	2.64±0.99	2.15±0.94	1.929^b	0.058
病理分型(例)			3.161^a	0.367
原位癌	3	8
高分化腺癌	1	0
中分化腺癌	5	11
低分化腺癌	15	20
T分期(例)			367.000^c	0.115
T1	10	22
T2	2	7
T3	12	10
N分期(例)			421.000^c	0.411
N0	15	29
N1	6	4
N2	0	2
N3a	2	3
N3b	1	1
注：^a为χ²值，^b为t值，^c为U值。

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表 2 2组胃癌患者术中和术后恢复情况比较

Table 2. Comparison of intraoperative and postoperative recovery between two groups of gastric cancer patients

项目	圆吻组(n=24)	π吻合组(n=39)	统计量	P值
清扫淋巴结数目(x±s，枚)	18.50±5.72	16.95±5.37	1.081^a	0.284
手术时间(x±s，min)	251.95±50.00	275.17±46.70	1.671^a	0.098
食管空肠吻合时间(x±s，min)	35.54±7.64	34.48±8.21	1.371^a	0.181
术中出血量[M(P₂₅, P₇₅)，mL]	40.00(30.00，87.50)	50.00(30.00，50.00)	379.500^b	0.171
肿瘤上切缘(x±s，cm)	2.03±0.53	2.11±0.42	0.618^a	0.539
肿瘤下切缘(x±s，cm)	5.96±1.12	5.57±0.63	1.778^a	0.080
切口长度(x±s，cm)	14.33±1.80	4.92±0.53	30.530^a	< 0.001
首次下地活动时间(x±s，d)	1.91±0.58	1.07±0.27	7.764^a	< 0.001
首次排气时间(x±s，d)	2.91±0.58	2.17±0.38	4.652^a	0.039
恢复全流食时间(x±s，d)	6.70±2.45	5.07±0.27	5.763^a	0.033
术后住院时间(x±s，d)	13.66±6.47	11.05±3.83	2.017^a	0.048
术后第1天WBC(x±s，×10⁹/L)	11.93±3.25	11.67±3.18	0.305^a	0.762
术后第1天Hb(x±s，g/L)	110.87±20.52	116.02±17.78	1.052^a	0.297
术后第3天NRS评分[M(P₂₅, P₇₅)，分]	2.00(0.00，2.00)	2.00(2.00，2.00)	285.500^b	0.003
注：^a为t值，^b为U值。

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表 3 2组胃癌患者术中并发症发生情况比较(例)

Table 3. Comparison of intraoperative complications between two groups of gastric cancer patients(cases)

组别	例数	胸膜破裂	脾血管出血	食管空肠吻合口出血
圆吻组	24	0	2	1
π吻合组	39	1	1	0
χ²值			0.189
P值		0.999^a	0.663	0.381^a
注：^a为采用Fisher精确检验。

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表 4 2组胃癌患者术后早期并发症发生情况比较(例)

Table 4. Comparison of early postoperative complications between two groups of gastric cancer patients(cases)

项目	圆吻组(n=24)	π吻合组(n=39)	统计量	P值
食管空肠吻合相关并发症			1.079^a	0.299
食管空肠吻合口瘘	3	0	2.734^a	0.098
食管空肠吻合口狭窄	0	1		0.999^c
肠梗阻	0	1		0.999^c
切口感染	4	0	4.421^a	0.036
胸腔积液	2	3	< 0.001^a	0.999
术后并发症分级	9	4	342.000^b	0.011
Ⅰ	3	1
Ⅱ	6	3
Ⅲ	0	0
Ⅳ	0	0
Ⅴ	0	0
注：^a为χ²值，^b为U值，^c为采用Fisher精确检验。

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