目的

探究全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响。

方法

回顾性分析2019年1月至2021年1月106例远端胃癌患者的临床资料，按照不同吻合方式分为毕Ⅰ氏组（行远端胃大部切除术、毕Ⅰ氏吻合术）与三角组（行远端胃大部切除术、三角吻合术），根据倾向性匹配评分排除混杂因素（卡钳值0.02），每组患者各53例。采用SPSS 22.0软件分析数据。围手术期指标、胃功能指标等计量资料以（±s）表示，组间比较行独立样本t检验；并发症发生率等计数资料行χ²检验。P＜0.05为差异有统计学意义。

结果

三角组患者手术时间、术中出血量、下床活动时间及首次进食流质时间显著低于毕Ⅰ氏组（P＜0.05），两组患者住院时间、淋巴结清扫数目差异不显著（P＞0.05）；三角组患者并发症发生率显著低于毕Ⅰ氏组（P＜0.05）；术后1d两组患者胃泌素（GAS）显著下降（P＜0.05），术后7d显著上升（P＜0.05），且三角组恢复情况显著优于毕Ⅰ氏组（P＜0.05），术后90d两组患者胃排空率、胃体蠕动次数显著上升（P＜0.05），且三角组显著高于毕Ⅰ氏组（P＜0.05）；随访3年，中位随访时间27个月，两组患者无进展生存期（PFS）差异不具有统计学意义（Log-Rankχ²=0.884，P=0.347），两组患者总生存期（OS）差异不具有统计学意义（Log-Rank χ²=1.182，P=0.279）。

结论

远端胃大部切除联合毕Ⅰ氏或三角吻合术均可有效治疗远端胃癌，恢复患者胃功能，与毕Ⅰ氏术相比，三角吻合术在提高患者胃功能，降低手术并发症方面具有显著优势，值得应用。

Objective

To explore the effects of different anastomotic methods of total laparoscopic distal subtotal gastrectomy on gastric function recovery and complication rate in patients with gastric cancer.

Methods

The clinical data of 106 patients with distal gastric cancer from January 2019 to January 2021 were retrospectively analyzed.According to different anastomosis methods， they were divided into Bi's group（underwent distal subtotal gastrectomy and Bi's anastomosis） and triangle group （underwent distal subtotal gastrectomy and triangular anastomosis）.Confounding factors were excluded according to propensity matching score （caliper value 0.02）.There were 53 patients in each group.SPSS 22.0 software was used to analyze the data.Measurement data such as perioperative indexes and gastric function indexes were expressed in the form of （x± s）， and independent sample t test was performed between groups.The complication rate and other statistical data were χ² test.P＜0.05 was considered statistically significant.

Results

The operative time， intraoperative blood loss， time to get out of bed and time to first feed fluid in triangle group were significantly lower than those in Bi Ⅰ group （P＜0.05）， while the length of hospital stay and number of lymph node dissection were not significantly different between the two groups （P＞0.05）.The complication rate of triangle group was significantly lower than that of Bi Ⅰ group （P＜0.05）.Gastrin （GAS） in the two groups was significantly decreased 1 day after surgery （P＜0.05）， and significantly increased 7 days after surgery （P＜0.05）， and the recovery of the triangle group was significantly better than that of the Bi's group（P＜0.05）， and the gastric empting rate and the number of stomach peristalsis in the two groups were significantly increased 90 days after surgery （P＜0.05）.The triangulation group was significantly higher than that of Bi's group （P＜0.05）.Follow-up was 3 years and the median follow-up was 27 months.There was no significant difference in progression-free survival （PFS） between the two groups （Log-Rankχ²=0.884， P=0.347），and overall survival （OS） between the two groups （Log-Rankχ²=1.182， P=0.279）.

Conclusion

Distal subtotal gastrectomy combined with Bidi's or triangular anastomosis can effectively treat distal gastric cancer and restore gastric function.Compared with Bidi's operation， triangular anastomosis has significant advantages in improving gastric function and reducing surgical complications， and is worthy of application.