食管空肠手工吻合与管型吻合在腹腔镜全胃切除术中的疗效对比

Comparison of the Efficacy of Oesophagojejunal Manual Anastomosis versus Tube-Type Anastomosis in Laparoscopic Total Gastrectomy

摘要: 背景：探讨腹腔镜全胃切除术中应用手工吻合和管型吻合的手术疗效及其对预后的影响。方法：我们回顾性分析了安徽医科大学第二附属医院胃肠外科2021年10月至2023年10月间收治的112例行腹腔镜全胃切除术胃癌患者的临床病理资料，并将其分为手工吻合组(H组，N = 60)和管型吻合组(C组，N = 52)，比较腹腔镜全胃切除术中应用手工吻合与管型吻合的手术疗效和预后情况。结果：两组在术中出血量、首次排气时间、术后住院时间、术后并发症等方面的差异均无统计学意义(P > 0.05)。H组的食管空肠吻合时间(20.40 ± 1.83 vs 34.71 ± 1.80)及手术时间更短(252.60 ± 21.91 vs 267.40 ± 19.42)、切口更小(5.07 ± 0.65 vs 10.47 ± 0.87)、住院费用更低(59496.04 ± 5555.51元 vs 64656.13 ± 4340.65元) (P < 0.05)。结论：腹腔镜全胃切除术中应用手工吻合的手术疗效及术后并发症与管型吻合的相当，其优势在于手术时间和吻合时间更短、切口更小、住院费用更低，对肿瘤位置具有更广泛的适应性。

Abstract: Objective: To investigate the surgical efficacy of applying manual and tubular anastomoses in laparoscopic total gastrectomy and its impact on prognosis. Methods: Retrospective analysis is adopted to the clinicopathologic data of 112 patients with gastric cancer (GC) who went through LTG in the Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University between October 2020 and October 2022. Among them, 60 individuals receiving medical care were split into the hand-sewn anastomosis group (Group H, N = 60); while, 52 individuals were split into the circular stapler anastomosis group (Group C, N = 52) The clinical efficacy and prognostic conditions of hand-sewn anastomosis are compared with those of circular stapler anastomosis in the application of LTG. Results: The analysis results indicated that no notable difference was observed in intraoperative bleeding volume, time to first flatus (TFF), postoperative hospitalization duration and postoperative complications among the two groups (P > 0.05). Group H had shorter esophagojejunal anastomosis time (20.40 ± 1.83 vs 34.71 ± 1.80) and operative time (252.60 ± 21.91 vs 267.40 ± 19.42), smaller incision (5.07 ± 0.65 vs 10.47 ± 0.87), and lower hospitalisation cost (59496.04 ± 5555.51 yuan vs 64656.13 ± 4340.65 yuan) (P < 0.05). Conclusion: The clinical efficacy and the postoperative complications of hand-sewn esophagojejunostomy are basically equivalent in comparison to the circular stapler anastomosis in the application of LTG. Its advantage lies in shorter esophagojejunal anastomosis duration, shorter surgery duration, smaller incisions, lower hospitalization costs and wider adaptability of the location of the tumor.