Ma P F, Cao Y H, Zhang J L, Liu C Y, Zhang X J, Li S, Han G S, Zhao Y Z
Department of General Surgery, the Affiliated Tumor Hospital of Zhengzhou University (Henan Tumor Hospital), Zhengzhou, Henan 450008, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Oct 25;23(10):969-975. doi: 10.3760/cma.j.cn.441530-20191010-00445.
For gastric cancer patients undergoing total gastrectomy, the esophagojejunal anastomosis is the main site of postoperative anastomotic leakage. How to improve the safety of the esophagojejunal anastomosis is a hot topic. This study evaluated the safety of double and a half layered esophagojejunal anastomosis in total gastrectomy for gastric cancer. A retrospective cohort study was conducted. Clinical data of 764 gastric cancer patients, who were diagnosed as gastric adenocarcinoma by preoperative gastroscopicbiopsy and were judged to be able to complete R0 resection by imaging examination, in the Affiliated Tumor Hospital of Zhengzhou University (Henan Cancer Hospital) from May 2015 to May 2019 were retrospectively collected and analyzed. two and a half layered esophagojejunal anastomosis was used in the treatment group (295 cases), and the routine anastomosis was used in the control group (469 cases). Postoperative complicating including anastomosis-assisted complications were compared between the two groups. The baseline data of two groups were not significantly different (all >0.05). All the patients successfully completed the operation. In observation group and control group, the total operative time [(140.7±27.0) minutes vs. (139.6±22.8) minutes], intraoperative blood loss [(200.6±111.0) ml vs. (214.4±114.1) ml], anastomosis time [(20.4±4.3) minutes vs. (19.9±4.6) minutes], time to first flatus [(4.1±1.1) days vs. (4.2±1.1) days], time to fluid diet [(5.4±1.0) days vs. (5.5±0.9) days], time to postoperative nasointestinal tube removal [(9.8±3.2) days vs. (10.0±2.3) days], and postoperative hospital stay [(15.4±6.5) days vs. (15.9±5.6) days] were not significantly different (all >0.05). Compared to the control group, the treatment group had lower rates of anastomosis-associated complications [1.7% (5/295) vs. 4.7% (22/469), χ(2)=4.768, =0.029] and anastomotic leakage [1.0% (3/295) vs.3.4% (16/469), χ(2)=4.282, =0.039]. The differences in the incidence of anastomotic stenosis and anastomotic bleeding were not statistically significant between the two groups (both >0.05). In the treatment group and control group, rates of total postoperative complication [34.2% (101/295) vs. 32.2% (151/469), χ(2)=0.838, =0.360] and severe complication [Clavinen-Dindo grade III and above; 4.7% (14/295) vs. 7.2% (34/469), =-1.465, =0.143] were not significantly different as well. Two and a half layered esophagojejunal anastomosis is safe and feasible in total gastrectomy for gastric cancer and can reduce anastomosis-associated complications.
对于接受全胃切除术的胃癌患者，食管空肠吻合口是术后吻合口漏的主要部位。如何提高食管空肠吻合的安全性是一个热门话题。本研究评估了胃癌全胃切除术中双层半食管空肠吻合的安全性。进行了一项回顾性队列研究。回顾性收集并分析了2015年5月至2019年5月在郑州大学附属肿瘤医院（河南省肿瘤医院）就诊的764例胃癌患者的临床资料，这些患者术前经胃镜活检诊断为胃腺癌，经影像学检查判断能够完成R0切除。治疗组（295例）采用双层半食管空肠吻合，对照组（469例）采用常规吻合。比较两组术后并发症（包括吻合相关并发症）。两组的基线数据无显著差异（均>0.05）。所有患者均成功完成手术。观察组和对照组的总手术时间[（140.7±27.0）分钟对（139.6±22.8）分钟]、术中出血量[（200.6±111.0）毫升对（214.4±114.1）毫升]、吻合时间[（20.4±4.3）分钟对（19.9±4.6）分钟]、首次排气时间[（4.1±1.1）天对（4.2±1.1）天]、流食时间[（5.4±1.0）天对（5.5±0.9）天]、术后鼻肠管拔除时间[（9.8±3.2）天对（10.0±2.3）天]及术后住院时间[（15.4±6.5）天对（15.9±5.6）天]均无显著差异（均>0.05）。与对照组相比，治疗组的吻合相关并发症发生率更低[1.7%（5/295）对4.7%（22/469），χ²=4.768，P=0.029]，吻合口漏发生率也更低[1.0%（3/295）对3.4%（16/469），χ²=4.282，P=0.039]。两组吻合口狭窄和吻合口出血的发生率差异无统计学意义（均>0.05）。治疗组和对照组的术后总并发症发生率[34.2%（101/295）对32.2%（151/469），χ²=0.838，P=0.360]和严重并发症发生率[Clavinen-Dindo分级III级及以上；4.7%（14/295）对7.2%（34/469），Z=-1.465，P=0.143]也无显著差异。双层半食管空肠吻合在胃癌全胃切除术中安全可行，可减少吻合相关并发症。
