Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China.
Technol Cancer Res Treat. 2020 Jan-Dec;19:1533033820973281. doi: 10.1177/1533033820973281.
To compare the short-term clinical effects between totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis, and laparoscopic-assisted radical gastrectomy with Roux-en-Y anastomosis; to explore the safety, feasibility and short-term effect of totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis.
Data of 75 patients who underwent totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis, and 95 patients who underwent laparoscopic-assisted radical gastrectomy with Roux-en-Y anastomosis by the same surgical team were analyzed. During the modified Roux-en-Y anastomosis, the stomach separation and regional lymph node dissection were completed under a laparoscope; the specimen was placed in a bag; gastrojejunostomy was completed; the subumbilicus hole was enlarged to 3 cm; the specimen was taken out; then, the proximal and distal ends of the small intestine were moved outside of the abdominal wall to complete the small intestine-small intestine end-to-side anastomosis.
All 170 operations were successful. The differences in the time of anastomosis and the number of dissected lymph nodes between the 2 groups were not statistically significant (P > 0.05), but in the totally-MA group the amount of bleeding and the length of incision significantly decreased (P < 0.05). The recovery time as measured by breathing unassisted, drinking fluids and getting out of bed was significantly shorter than those in the laparoscopic-assisted group (P < 0.05), and the pain score 1 day after surgery was significantly lower than that of the laparoscopic-assisted group (P < 0.05). One case of duodenal stump leakage and 1 case of esophagojejunostomy leakage were found in the laparoscopic-assisted group. In the totally-MA group, there were no complications such as anastomotic leakage, anastomotic stenosis or anastomotic bleeding, but 2 patients with double primary carcinoma underwent joint radical resection.
Compared with laparoscopic-assisted surgery, totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis has the advantages of being safer and less traumatic, with associated reductions in bleeding and pain.
比较全腹腔镜改良 Roux-en-Y 吻合与腹腔镜辅助 Roux-en-Y 吻合根治性胃切除术的短期临床效果，探讨全腹腔镜改良 Roux-en-Y 吻合根治性胃切除术的安全性、可行性及短期疗效。
分析同一手术团队行全腹腔镜改良 Roux-en-Y 吻合根治性胃切除术（改良 Roux-en-Y 吻合组）和腹腔镜辅助 Roux-en-Y 吻合根治性胃切除术（腹腔镜辅助 Roux-en-Y 吻合组）的 75 例和 95 例患者资料。改良 Roux-en-Y 吻合时，在腹腔镜下完成胃分离和区域淋巴结清扫；标本装入袋内；完成胃空肠吻合；脐下小孔扩大至 3cm，取出标本；然后将小肠近端和远端移至腹壁外，完成小肠-小肠侧侧吻合。
170 例手术均成功。两组吻合时间、清扫淋巴结数量的差异无统计学意义（P>0.05），但改良 MA 组术中出血量、切口长度明显减少（P<0.05）。自主呼吸、饮水、下床活动恢复时间明显短于腹腔镜辅助组（P<0.05），术后 1 天疼痛评分明显低于腹腔镜辅助组（P<0.05）。腹腔镜辅助组发生十二指肠残端漏 1 例、食管空肠吻合口漏 1 例，改良 MA 组无吻合口漏、吻合口狭窄或吻合口出血等并发症，但 2 例双原发癌患者行联合根治切除。
与腹腔镜辅助手术相比，全腹腔镜改良 Roux-en-Y 吻合根治性胃切除术具有更安全、创伤更小的优点，术中出血量和疼痛减少。
