Objective To compare the clinical efficacy of totally laparoscopic gastrectomy (TLG) and conventional laparoscopic-assisted gastrectomy (LAG),and to explore the safety and feasibility of the total laparoscopic Roux-en-Y anastomosis in laparoscopic gastrectomy.Methods The clinical data of 78 patients who received TLG and other 72 patients who received conventional LAG in our department from May 2014 to June 2015 were retrospectively analyzed.Results All procedures were completed successfully.There were no significant differences in mean time of anastomosis and number of dissected lymph nodes between the two group (P>0.05).There was marked difference in the mean blood loss and the mean incision length between two groups (P<0.05).As compared with the LAG group,the postoperative pain days,the hospital stay days,the mean off-bed time,time to fluid intake and time to flatus were significantly shortened in the TLG group (all P<0.05).All the patients were followed up for 6 months.The rate of complications related to the anastomosis was 4.2% (3/72) in the LAG group,and no complications related to the anastomosis occurred in the TLG group.These complications included anastomotic leakage,stenosis,bleeding,duodenum stump fistula and intestinal obstruction.Conclusions Total laparoscopic Roux-en-Y anastomosis is safe and feasible in laparoscopic gastrectomy for gastric cancer.Compared to small incision-assisted anastomosis,totally laparoscopic anastomosis is associated with minimal trauma,less blood less,quicker postoperative recovery,shorter hospital stay,less pain and more satisfactory short-term efficacy.%目的 探讨完全腹腔镜下Roux-en-Y吻合技术在远端胃癌根治术的安全性及可行性.方法 回顾性分析2014年5月至2015年6月150例远端胃癌根治术Roux-en-Y吻合病人的临床资料,其中78例行完全腹腔镜胃癌根治术(total laparoscopic gastrectomy,TLG)和72例行腹腔镜辅助下胃癌根治术(laparoscopy-assisted gastrectomy,LAG).结果 150例手术均获成功,术后病理检查切缘均为阴性.TLG组平均手术时间为(261.4±30.9) min,与LAG组的(258.1±26.7) min相比,差异无统计学意义(P>0.05).TLG组切除淋巴结为(32.4±9.2)枚,与LAG组切除淋巴结(33.5±9.4)枚相比,差异无统计学意义(P>0.05).但TLG组术中出血量明显少于LAG组[(270.7±63.4) ml 比(372.9±84.6) ml,P<0.05],手术切口长度明显短于LAG组[(3.1±0.8) cm 比(7.3±1.6) cm,P<0.05],差异均有统计学意义.同时,TLG组术后镇痛天数、住院时间、首次下床活动时间、首次进食流质时间、术后肛门排气时间均较LAG组显著缩短,差异有统计学意义(均P<0.05).术后随访6个月,LAG组吻合口相关并发症发生率为4.2%(3/72),TLG组均未出现吻合口漏、吻合口狭窄、吻合口出血、十二指肠残端瘘或肠梗阻等相关并发症.结论 完全腹腔镜下远端胃癌根治术Roux-en-Y吻合技术是安全、可行的,与小切口腹腔镜辅助吻合相比具有创伤小、出血少、恢复快、住院时间短及疼痛感轻等优势,近期效果显著.
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