张灼新+吴祖光+李恩

[摘要] 目的 探讨腹腔镜远端胃癌根治术胃空肠Uncut Roux-en-Y吻合的安全性和可行性。方法 回顾性分析我院实施的20例全腹腔镜远端胃癌根治术胃空肠Uncut Roux-en-Y吻合患者的临床资料，并选择20例腹腔镜辅助远端胃癌根治术胃空肠Uncut Roux-en-Y吻合患者作为对照组，对两组患者手术指标和临床疗效进行对比分析。 结果 本次研究纳入的40例患者均手术成功。两组患者手术情况之间比较，差异无统计学意义（P>0.05）。两组术后病理分期比较差异无统计学意义（P>0.05）。两组患者术后并发症比较显示，观察组吻合口出血、Roux 滞留综合征、反流性食管炎和残胃炎发生例数少于对照组，总并发症发生率低于对照组（P<0.05）。 结论 腹腔镜下uncut Roux-en-Y吻合在远端胃癌根治术中是安全、可行的，具有良好的临床应用价值。

[关键词] 腹腔镜；Uncut Roux-en-Y吻合；远端胃癌根治术

[中图分类号] R735.2 [文献标识码] A [文章编号] 2095-0616（2017）13-174-04

[Abstract] Objective To explore the feasibility and safety of laparoscopic uncut Roux-en-Y anastomosis in distal gastectomy. Methods The clinical data of 20 in-hospital cases with laparoscopic Uncut Roux-en-Y anastomosis in distal gastectomy were retrospectively analyzedis.And 20 cases of laparoscopic assisted distal gastric cancer treated with Uncut Roux-en-Y anastomosis were chosen as the control group.The surgical indexes and clinical curative effects of the two groups were compared. Results All patients underwent successful operation.There was no significant difference between the operation index of the two group（P>0.05）.The results of postoperative pathological staging showed that there were no significant differences between the two groups（P>0.05）.Compared with the control group，the number of cases of anastomotic bleeding，Roux retention syndrome，reflux esophagitis and residual gastritis were less than those in the control group，and the total complications of treatment group was lower than that of the control group（P<0.05）. Conclusion Laparoscopic Uncut Roux-en-Y anastomosis in distal gastectomy is safe and feasible.It should be extended in clinic.

[Key words] Laparoscopic；Uncut Roux-en-Y anastomosis；Distal gastectomy

随着腹腔镜技术经验的积累及器械的发展，腹腔镜胃癌手术已實现规范化的淋巴结清扫，并呈现出取代传统开腹手术的趋势。消化道重建是腹腔镜胃癌手术的主要难点之一，尤其是全腹腔镜下的消化道重建难度更大[1]。理想的消化道重建不仅能够保障手术本身的安全性，更能够保证胃癌患者术后的营养需要和生存质量[2]。全腹腔镜远端胃癌根治术消化道重建方式主要有Billroth-Ⅰ、Billroth-Ⅱ及Roux-en-Y 吻合3种[3]。Billroth-Ⅰ、Billroth-Ⅱ两种重建方式操作相对简单，但均具有其明显的缺陷。Roux-en-Y 吻合包括传统 Roux-en-Y 吻合和非离断式（Uncut）Roux-en-Y 吻合，操作相对复杂，但相对适应证广，更符合人体生理，可有效提高患者术后的生活质量[4-5]。而Uncut Roux-en-Y吻合适用范围更广，且明显减少了传统Roux-en-Y 吻合的 Roux 滞留综合征发生率。本文……