【作者】 单毓强； 陈友雷； 朱阿考； 尹光； 余盼攀； 孔文成； 李江涛； 朱玮； 金慧成；

【机构】 杭州市第一人民医院；

【摘要】 目的 :比较完全腹腔镜下π式吻合和OrVil吻合在全胃切除术中应用的临床疗效和安全性。方法 :回顾性分析2016年1月至2017年3月间杭州市第一人民医院收治的36例行完全腹腔镜下全胃切除的胃癌患者的病例资料,其中19例患者行π式吻合(π组),17例患者行OrVil吻合(OrVil组),比较两组患者的一般临床资料、术中情况及术后恢复情况等。结果 :两组患者的一般临床资料,包括性别、年龄、BMI、ASA分级、NRS评分、AJCC TNM分期及合并症差异无统计学意义(P> 0.05);术中情况中,两组患者的术中出血量和清扫淋巴结个数差异无统计学意义(P> 0.05),但π组手术时间、消化道重建时间小于OrVil组(P <0.05);术后恢复方面,两组患者的术后镇痛时间和下床活动时间差异无统计学意义(P> 0.05),但π组肛门排气时间和术后住院时间小于OrVil组(P <0.05);术后并发症方面,π组患者总并发症发生率显著低于OrVil组患者(P<0.01)。π组患者无术后并发症发生;OrVil组发生吻合口瘘1例,吻合口狭窄1例,腹腔感染1例。结论 :这两种吻合方式在全腹腔镜全胃切除术中应用均是安全可行的,但π式吻合在手术时间、消化道重建时间,术后康复及减少术后并发症方面疗效优于OrVil吻合。更多还原

【Abstract】 Objective To compare the clinical efficacy and safety of π and OrVil anastomosis in total laparoscopic total gastrectomy.Methods Clinical data of the patients who accepted total laparoscopic total gastrectomyfrom January 2016 to March 2017 in Hangzhou first people’s hospital was retrospectively analysed,including 19 patients of π anastomosis(π group)and 17 patients of OrVil(OrVil group),the general clinical data,intraoperative and postoperative outcomes were compare between the two groups.Results There wer no significantly differentences in the general clinical data of the two groups,including gender,age,BMI,ASA,NRS score,classificationof AJCC TNM and complications(P> 0.05);as well as the blood loseduring operation and number of lymph node dissection(P>0.05),but the operation time and time of digestive tract reconstruction of π group were less than those of theOrVilgroup(P<0.05).Time of postoperative analgesics and earlier ambulation were notsignificantly differenctbetweenthe two groups(P> 0.05),but the π group presented faster intestinal recovery,shorter hospital stay(P< 0.05)and lower morbidity of postoperative complication than the OrVil group(P< 0.01).One patient developed anastomotic leakage,one developed anastomotic stricture and one developed abdominal infection in the π group.No complications occurred in theOrVil Group.Conclusion Both of the two types of anastomosis is safe and feasible in the application of total laparoscopic total gastrectomy,but the π anastomosis is better than the OrVilanastomosis in reducing operative durations and the time of digestive tract reconstruction,speeding up recovery and reducing postoperative complications.更多还原