【摘要】 目的 探讨食管空肠π形吻合与overlap吻合行全腹腔镜全胃切除术后消化道重建的临床效果。方法 选取2018年6月至2021年6月在我院行全腹腔镜全胃切除术的102例胃癌患者行回顾性分析，按消化道重建吻合方式分为π形吻合组及overlap吻合组，各51例。比较两组患者围术期相关指标、术后营养状况、生活质量、并发症及预后。结果 两组手术时间、术中出血量、切口长度、术后首次排气及恢复进食时间、住院时间比较均无统计学差异(P>0.05),而π形吻合组吻合时间短于overlap吻合组(P<0.05)。两组患者术后3个月Alb、Hb、PAB、TP、RBC、球蛋白及铁蛋白等营养指标及QLQ-C30评分均明显改善(P<0.05),但两组间各营养指标及QLQ-C30评分比较均无统计学差异(P>0.05)。π形吻合组及overlap吻合组术后早、晚期并发症发生率分别为15.69%和21.57%、 9.80%和7.84%,组间比较均无统计学差异(P>0.05)。术后均随访6～36个月，π形吻合组和overlap吻合组死亡率分别为27.45%和31.37%,两组患者平均生存时间无统计学差异(χ~2=0.367,P=0.545)。结论 全腹腔镜全胃切除术中采用食管空肠π形吻合与overlap吻合技术行Roux-en-Y吻合均可有效改善患者的营养状况及生存质量，安全性较高，可作为消化道重建的选择方式之一。更多还原

【Abstract】 Objective To explore the effect of π-shaped esophagojejunostomy and overlap esophagojejunostomy in the digestive tract reconstruction of totally laparoscopic total gastrectomy. Methods A total of 102 gastric cancer cases underwent totally laparoscopic total gastrectomy in our hospital from June 2018 to June 2021 were analyzed retrospectively, and were divided into π-shaped anastomosis group and overlap anastomosis group according to anastomosis procedure of digestive tract reconstruction, with 51 cases for each group. The peri-operative indexes, post-operative nutritional status, quality of life, complications and prognosis was compared between the two groups. Results There were no significant differences in the operation time, intra-operative blood loss volume, incision length, first exhaust time and first meal time after the operation and hospital stays between the two groups(P>0.05), but the anastomosis time was shorter in the π-shaped anastomosis group than that in the overlap anastomosis group(P<0.05). The nutritional indexes of Alb, Hb, PAB, TP, RBC, globulin and ferritin and QLQ-C30 scores were improved significantly in both groups three months after the operation(P<0.05). However, no statistical difference was found in nutritional indexes mentioned above and QLQ-C30 scores between the two groups(P>0.05). The post-operative complication rates of early and late stagewas 15.69% vs. 21.57% and 9.80% vs. 7.84% in the π-shaped anastomosis group and the overlap anastomosis grouprespectively, without statistical differences between the two groups(P>0.05). All cases were followed up for 6 to 36months. The mortality rate was 27.45% and 31.37% in the π shaped anastomosis group and the overlap anasto-mosis group, respectively. There was no significant difference in the average survival period between the twogroups （χ~2= 0.367,P= 0.545）． Conclusion Both π-shaped esophagojejunostomy and overlap esophagojeju-nostomy can improve the nutritional status and quality of life of gastric cancer patients with high safety in Roux-en-Y anastomosis of total laparoscopic total gastrectomy, and can be a recommended selection of gastrointestinalreconstruction procedure.更多还原