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目的探讨全腹腔镜远端胃癌根治术胃空肠非离断式(Uncut)Roux-en-Y吻合的安全性、可行性和短期疗效。方法回顾性分析2014年9月至2015年12月上海交通大学医学院附属瑞金医院实施的全腹腔镜远端胃癌D2根治术胃空肠Uncut Roux-en-Y吻合51例临床资料,观察手术时间、术中出血量、淋巴结清扫总数、并发症发生率、住院天数和随访结果。结果全组51例病例均在全腹腔镜下成功完成,无中转开腹,无术中并发症,无手术相关死亡。手术平均时间为170(135~210)min,其中消化道重建时间为27(24~41)min,术中平均失血为60(30~110)m L。术后平均排气时间2(1~3)d,手术后平均住院天数8(7~12)d。术后1例(2.0%)出现吻合口出血,予以保守治疗后好转。无吻合口漏、十二指肠残端瘘和Roux滞留综合征等相关并发症发生。术后短期随访9(5~20)个月。术后每6个月复查胃镜和胃肠道造影,无反流性胃炎,无空肠阻断处再通。结论全腹腔镜远端胃癌根治术胃空肠Uncut Roux-en-Y吻合安全、可行,且具有全腹腔镜下操作简便,术后近期再通率低,既避免了Billroth-Ⅱ式吻合的反流性胃炎,又避免了Roux-en-Y吻合的Roux滞留综合征,有临床应用价值。
Objective To investigate the safety, feasibility and short-term curative effect of Uncut Roux-en-Y anastomosis in distal laparoscopic radical gastrectomy for gastric cancer. Methods Retrospective analysis of 51 cases of Gastric-jejunal Uncut Roux-en-Y anastomosis in D2 radical resection of distal root canal from September 2014 to December 2015 in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine was performed. The clinical data of operation time, Intraoperative blood loss, total lymph node dissection, complication rate, days of hospitalization and follow-up results. Results The whole group of 51 cases were successfully completed in total laparoscopic surgery without laparotomy, no intraoperative complications, no operative death. The average operation time was 170 (135-210) min, including 27 (24-41) min of digestive tract reconstruction and 60 (30-110) m L of blood loss on average. The average postoperative exhaust time was 2 (1-3 days), and the average postoperative hospital stay was 8 (7-12) days. Anastomotic bleeding occurred in 1 patient (2.0%) after operation, and was improved after conservative treatment. No anastomotic leakage, duodenal stump fistula and Roux stagnation syndrome and other related complications. Short-term follow-up 9 (5 ~ 20) months. Gastroscopy and gastrointestinal radiography were performed every 6 months after surgery, without reflux gastritis and without recanalization of the jejunum. Conclusions Laparoscopic distal gastric cancer radical resection of gastric jejunum Uncut Roux-en-Y anastomosis safe and feasible, and has the whole laparoscopic operation is simple, short-term postoperative recanalization rate, both to avoid the Billroth-Ⅱ anastomosis reflux Gastritis, Roux-en-Y Roux stay consistent with the retention syndrome, has clinical value.