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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 106 -110. doi: 10.3877/cma.j.issn.1674-0793.2022.02.004

论著

全腹腔镜下全胃切除术后多点位固定-Overlap法和传统Overlap法疗效及安全性的对比研究
丁平安1, 王冬1,†(), 赵群1, 张志栋1, 贾楠1, 郭洪海1, 胡涛1, 崔平2, 李勇1   
  1. 1. 050011　石家庄，河北医科大学第四医院外三科
    2. 050051　石家庄，河北省人民医院医务处
  • 收稿日期:2021-10-08 出版日期:2022-04-01
  • 通信作者: 王冬
  • 基金资助:
    河北卫健委县级公立医院适宜卫生技术推广入库项目(2019024); 政府资助临床医学优秀人才培养项目(2019012); 河北省高等学校科学技术研究项目(ZD2019139)

Comparative study on the short-term efficacy and safety of multipoint fixed-Overlap method and traditional Overlap method after totally laparoscopic gastrectomy

Ping’an Ding1, Dong Wang1,†(), Qun Zhao1, Zhidong Zhang1, Nan Jia1, Honghai Guo1, Tao Hu1, Ping Cui2, Yong Li1   

  1. 1. Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
    2. Medical Service, Hebei Provincial People’s Hospital, Shijiazhuang 050051, China
  • Received:2021-10-08 Published:2022-04-01
  • Corresponding author: Dong Wang
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丁平安, 王冬, 赵群, 张志栋, 贾楠, 郭洪海, 胡涛, 崔平, 李勇. 全腹腔镜下全胃切除术后多点位固定-Overlap法和传统Overlap法疗效及安全性的对比研究[J/OL]. 中华普通外科学文献(电子版), 2022, 16(02): 106-110.

Ping’an Ding, Dong Wang, Qun Zhao, Zhidong Zhang, Nan Jia, Honghai Guo, Tao Hu, Ping Cui, Yong Li. Comparative study on the short-term efficacy and safety of multipoint fixed-Overlap method and traditional Overlap method after totally laparoscopic gastrectomy[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(02): 106-110.

目的

探讨多点位固定-Overlap法（MF-Overlap）在全腹腔镜下根治性全胃切除术（TLTG）后食管-空肠吻合中的可行性及安全性。

方法

回顾性分析河北医科大学第四医院外三科2020年12月至2021年7月收治的64例采用Overlap法行TLTG胃癌患者的临床资料。依据消化道重建方式不同，分为传统Overlap组（35例）和MF-Overlap组（29例），比较两组患者手术及术后恢复情况。

结果

64例患者均顺利完成TLTG，无中转开腹及围手术期死亡。与传统Overlap组比较，MF-Overlap组总手术时间[（255.5±5.6）min vs（271.2±3.3）min，t=-3.358，P=0.012]、食管-空肠吻合时间[（42.1±3.1）min vs（53.1±5.6）min，t=-6.146，P=0.007]和术后住院时间[（6.6±2.1）d vs（7.8±2.4）d，t=-3.256，P=0.003]明显缩短，同时吻合口并发症发生率明显降低（0 vs 20.00%，χ2=6.513，P=0.011）。两组患者术中出血量、淋巴结清扫数目、肠道恢复时间及术后其他并发症率比较，差异无统计学意义。

结论

与传统Overlap法比较，MF-Overlap法用于TLTG食管-空肠吻合，可简化吻合过程，缩短手术时间，吻合安全可行，疗效较为满意。

关键词: 胃肿瘤, 全胃切除术, 食管-空肠吻合, 腹腔镜, Overlap吻合
Objective

To evaluate the feasibility and safety of multipoint fixed-overlap (MF-Overlap) in esophagojejunostomy after totally laparoscopic total gastrectomy (TLTG).

Methods

The clinical and pathological data of 64 gastric cancer patients with TLTG treated in the Department of Surgery, the Fourth Hospital of Hebei Medical University from December 2020 to July 2021 were retrospectively analyzed. According to different digestive tract reconstruction methods, the patients were divided into the traditional Overlap group (35 cases) and the MF-Overlap group (29 cases), and the operation and postoperative recovery were compared between the two groups.

Results

All 64 patients successfully completed TLTG, with no conversion to open surgery or perioperative death. Compared with the traditional Overlap group, the total operation time of MF-Overlap group [(255.5±5.6) min vs (271.2±3.3) min, t=-3.358, P=0.012], esophageal-jejunal anastomosis time [(42.1±3.1) min vs (53.1±5.6) min, t=-6.146, P=0.007], and postoperative hospital stay [(6.6±2.1) d vs (7.8±2.4) d, t=-3.256, P=0.003] were significantly shortened, and the incidence of anastomotic complications (0 vs 20.00%, χ2=6.513, P=0.011) was significantly decreased. There were no significant differences in intraoperative blood loss, the number of lymph node dissection, intestinal recovery time and other postoperative complications between the two groups.

Conclusion

Compared with the traditional Overlap method, MF-Overlap can simplify the anastomosis process, shorten the operation time, and is safe and feasible for esophageal-jejunal anastomosis after TLTG with satisfactory curative effect.

Key words: Gastric neoplasms, Total gastrectomy, Esophageal-jejunal anastomosis, Laparoscopy, Overlap anastomosis
图1 MF-Overlap法操作过程　A~I详细步骤说明见内文
表1 两组全腹腔镜下全胃切除术患者一般资料比较
临床病理特征 传统Overlap组 MF-Overlap组 统计值 P值
例数 35 29    
性别(例)     χ2=0.388 0.533
  男 22 16    
  女 13 13    
年龄(岁,±s) 55.1±5.6 56.1±4.8 t=1.825 0.583
体质指数(kg/m2,±s) 21.5±2.3 22.1±1.4 t=0.642 0.262
ECOG评分     χ2=0.457 0.499
  0 30 23    
  1 5 6    
伴发病数(个)     χ2=1.287 0.257
  0~1 23 15    
  ≥2 12 14    
PG-SGA评分(分,±s) 3.4±1.8 3.1±1.6 t=3.167 0.393
Borrmann分型     χ2=0.160 0.690
  Ⅰ ~Ⅱ 20 18    
  Ⅲ~Ⅳ 15 11    
pTNM分期     χ2=1.123 0.570
  Ⅰ 12 11    
  Ⅱ 16 15    
  Ⅲ 7 3    
表2 两组全腹腔镜下全胃切除术患者术中及术后恢复情况比较（±s）
组别 例数 术中情况 术后恢复情况(d)
总手术时间(min) 食管-空肠吻合时间(min) 淋巴结清扫数目(枚) 术中出血量(ml) 术后首次下床活动时间 术后首次排气时间 术后开始进食流食时间 术后住院时间
传统Overlap组 35 271.2±3.3 53.1±5.6 29.0±8.3 98.7±42.3 2.0±0.8 3.2±2.7 5.2±1.3 7.8±2.4
MF-Overlap组 29 255.5±5.6 42.1±3.1 31.0±9.3 96.2±32.3 1.5±0.3 3.0±1.3 4.7±2.1 6.6±2.1
t值   -3.358 -6.146 -1.482 -1.874 -1.765 -2.675 -1.783 -3.256
P值   0.012 0.007 0.167 0.605 0.098 0.076 0.053 0.003
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