Application of modified SPLT esophagojejunostomy in laparoscopic total gastrectomy

doi:10.3877/cma.j.issn.1674-3946.2025.02.025.

Abstract

Abstract:

Objective

To investigate the effect of modified self-traction post-dissection (SPLT)esophagojejunostomy in laparoscopic total gastrectomy (LTG).

Methods

The clinical data of 180 patients with gastric cancer who received LTG from January 2019 to October 2023 were retrospectively analyzed.Patients were divided into modified SPLT group and Roux-en-Y group according to different intraoperative esophagojejunal anastomosis methods.In the modified SPLT group, 120 patients underwent modified SPLT esophagojejunostomy, and in the Roux-en-Y group, 60 patients underwent traditional esophagojejunostomy.SPSS 22.0 software was used to analyze the data.Surgical indicators, intestinal mucosal barrier function indicators and other measurement data were expressed as (x±s), and independent sample t test was used.The statistical data of postoperative complications were analyzed by χ² test.P＜0.05 was considered to be statistically significant.

Results

Operation time, anastomosis time, intraoperative blood loss, intestinal sound recovery time and postoperative VAS score in modified SPLT group were significantly lower than those in Roux-en-Y group (P＜0.05).There was no significant difference in hospital stay and number of lymph nodes dissection between the two groups (P＞0.05).The overall incidence of postoperative complications in the modified SPLT group was significantly lower than that in the Roux-en-Y group (5.8% vs.16.7%, P＜0.05).The serum levels of D-lactate (D-LAC), diamine oxidase (DAO) and endotoxin (ET) in 2 groups were significantly increased after surgery (P＜0.05), but the three indexes in modified SPLT group were significantly lower than those in Rouxen-Y group (P＜0.05).

Conclusion

The application of modified SPLT esophagojejunostomy in LTG can not only simplify the anastomosis process, shorten the operation time and reduce the intraoperative injury, but also reduce the postoperative pain of patients and reduce the risk of complications.Besides, it has less impact on the intestinal mucosal barrier function and is more conducive to the recovery of gastrointestinal function, which is worthy of promotion.

Key words: Stomach Neoplasms, Laparoscopes, Gastrectomy, Anastomosis, Roux-en-Y, Self-Pulling and Latter Transection

Linqiang Xue, Jungang Ge, Lin Gao, Leimin Qian, Jianming Huang. Application of modified SPLT esophagojejunostomy in laparoscopic total gastrectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 212-215.

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https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2025/V19/I02/212

Figures/Tables 4

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	性别（例）	合并疾病（例）	体重指数（kg/m²， $\overset{ˉ}{x}$ ±s）
组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	男/女	有/无	体重指数（kg/m²， $\overset{ˉ}{x}$ ±s）
Roux-en-Y组	60	59.3±8.5	36/24	33/27	23.0±3.1
改良SPLT组	120	60.8±8.7	68/52	54/66	23.2±3.2
t/χ²/Z值		1.099	0.182	1.602	0.399
P值		0.137	0.670	0.206	0.345
组别	例数	肿瘤部位（例）	肿瘤长径（cm， $\overset{ˉ}{x}$ ±s）	cTNM分期（例）
组别	例数	A/B	肿瘤长径（cm， $\overset{ˉ}{x}$ ±s）	Ⅰ/Ⅱ/Ⅲ
Roux-en-Y组	60	20/40	4.0±1.5	19/27/14
改良SPLT组	120	49/71	4.2±1.7	33/52/35
t/χ²/Z值		0.952	0.773	-0.840
P值		0.329	0.220	0.401

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	性别（例）	合并疾病（例）	体重指数（kg/m²， $\overset{ˉ}{x}$ ±s）
组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	男/女	有/无	体重指数（kg/m²， $\overset{ˉ}{x}$ ±s）
Roux-en-Y组	60	59.3±8.5	36/24	33/27	23.0±3.1
改良SPLT组	120	60.8±8.7	68/52	54/66	23.2±3.2
t/χ²/Z值		1.099	0.182	1.602	0.399
P值		0.137	0.670	0.206	0.345
组别	例数	肿瘤部位（例）	肿瘤长径（cm， $\overset{ˉ}{x}$ ±s）	cTNM分期（例）
组别	例数	A/B	肿瘤长径（cm， $\overset{ˉ}{x}$ ±s）	Ⅰ/Ⅱ/Ⅲ
Roux-en-Y组	60	20/40	4.0±1.5	19/27/14
改良SPLT组	120	49/71	4.2±1.7	33/52/35
t/χ²/Z值		0.952	0.773	-0.840
P值		0.329	0.220	0.401

组别	例数	手术时间（min）	吻合时间（min）	术中出血量（ml）	肠鸣音恢复时间（h）
Roux-en-Y组	60	213.1±31.4	27.2±5.2	113.1±48.6	18.2±5.3
改良SPLT组	120	198.6±25.5	25.4±4.6	97.9±40.3	16.7±5.1
t值		3.323	2.368	2.224	1.836
P值		0.001	0.009	0.014	0.034
组别	例数	术后VAS评分（分）	术后住院时间（d）	淋巴结清扫枚数（枚）
Roux-en-Y组	60	3.5±0.7	11.8±2.5	28.5±6.0
改良SPLT组	120	3.2±0.6	11.2±2.3	29.2±6.7
t值		2.988	1.335	0.709
P值		0.002	0.092	0.240

组别	例数	切口感染	吻合口漏	吻合口狭窄	胸腔积液	肠梗阻	总并发症
Roux-en-Y组	60	2(3.3)	3(5.0)	2(3.3)	1(1.7)	2(3.3)	10(16.7)
改良SPLT组	120	1(0.8)	1(0.8)	1(0.8)	2(1.7)	2(1.7)	7(5.8)
χ ²值		-	-	-	-	-	5.489
P值		-	-	-	-	-	0.019

组别	例数	时间	D-LAC(mg/L)	DAO(U/ml)	ET(EU/ml)
Roux-en-Y组	60	术前	10.9±2.1	2.3±0.2	0.4±0.1
Roux-en-Y组	60	术后	13.1±2.6^a	3.4±0.5^a	0.6±0.1^a
改良SPLT组	120	术前	11.0±2.0	2.2±0.2	0.4±0.1
改良SPLT组	120	术后	12.3±2.4^ab	2.6±0.3^ab	0.5±0.1^ab

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