探讨腹腔镜根治性全胃切除术后采用线型吻合器进行体内完全腔镜下吻合的临床效果。

回顾性分析2019年3月至2021年3月间收治的40例胃中上部癌患者的临床资料，均行腹腔镜全胃切除术并使用Roux-en-Y方法进行消化道重建，其中A组22例采用体外开放吻合，B组18例采用体内完全腔镜下吻合。采用SPSS 11.5软件包进行统计学处理，围术期各项指标等计量资料用(±s)表示，采用独立t检验；术后早期和术后3个月并发症发生情况比较采用χ²检验，P<0.05差异有统计学意义。

B组患者的手术时间、术中出血量、切口长度、术后24 h VAS疼痛评分、术后首次排气时间等方面均显著优于A组(P<0.05)，而两组患者在淋巴结清扫数目方面相比较差异无统计学意义(P>0.05)。术后早期并发症和术后远期并发症比较，两组差异无统计学意义(P>0.05)。

腹腔镜根治性全胃切除术后，在进行Roux-en-Y消化道重建时，采用线型吻合器进行体内完全腔镜下吻合较体外开放吻合具有显著的优势，值得临床应用。

To study the clinical effect of totally laparoscopic anastomosis using linear stapler after total gastrectomy.

The 40 cases of upper and middle gastric cancer that received laparoscopic total gastrectomy and digestive tract reconstruction with Roux-en-Y method treated in our hospital from Mar 2019 to Mar 2021 were retrospectivly analyzed. The open anastomosis using circular stapler was performed in Group A(22 cases), and totally laparoscopic anastomosis using linear stapler was performed in Group B(18 cases). The clinical data and postoperative complications were collected and analyzed. Statistical software SPSS 11.5 was used for analysis. The perioperative measurement data of the two groups were presented as (±s), and compared with independent t test. The postoperative complications were determined by χ² test. P<0.05 was considered statistically significant.

The operative time, blood loss, incision length, scores of pain severity at 24 hours after operation, first exhaust time were significantly better in Group B than Group A(P<0.05). No significant difference was noted between the two groups in terms of early and late postoperative complications(P>0.05).

It is better to do totally laparoscopic anastomosis using linear stapler than open anastomosis using circular stapler after total gastrectomy.