腹腔鏡uncutRoux—en—Y吻合與傳統吻合方式的研究進展

林躍韓　許慶文

摘 要：隨著胃癌患者術后5年生存率的提高，患者對獲得更好的術后生活質量的要求也不斷提高，這與手術中消化道重建的方式有關，目前腹腔鏡手術的應用已被多數普外科醫生接受，但消化道重建的選擇方式尚未統一。傳統的3種吻合方式各有其優缺點，但共同弊端是會影響患者術后的生存質量。Uncut Roux-en-Y吻合術能夠阻斷腸道消化液返流，同時保持完整的腸道電生理，患者術后并發癥少，將可能成為最理想的消化道重建方式。現就腹腔鏡uncut Roux-en-Y吻合與傳統吻合方式對胃癌患者術后生活質量的影響進行綜述，分析各種吻合方式的優缺點。

關鍵詞：腹腔鏡；胃癌；Uncut roux-en-Y吻合；消化道重建

中圖分類號：R735.2 文獻標識碼：A DOI：10.3969/j.Ⅰssn.1006-1959.2018.22.010

文章編號：1006-1959（2018）22-0031-04

Research Progress of Laparoscopic uncut Roux-en-Y Anastomosis and Traditional Anastomosis

LIN Yue-han1，XU Qing-wen2

（1.Guangdong Medical University，Zhanjiang 524000，Guangdong，China；

2. Affiliated Hospital of Guangdong Medical University，Zhanjiang 524000，Guangdong，China）

Abstract：With the improvement of 5-year survival rate in patients with gastric carcinoma， the demand for better postoperative quality of life is also increasing， which is related to the way of digestive tract reconstruction during operation.At present，the application of laparoscopic surgery has been accepted by most general surgeons， but the choice of digestive tract reconstruction is not uniform.The traditional three anastomosis methods have their own advantages and disadvantages， but the common disadvantage is that the quality of life after operation will be affected.Uncut Roux-en-Y anastomosis can block digestive fluid regurgitation and maintain complete intestinal electrophysiology， which may be the most ideal way to reconstruct digestive tract.The effect of laparoscopic uncut Roux-en-Y anastomosis and traditional anastomosis on postoperative quality of life of gastric carcinoma patients was reviewed and the advantages and disadvantages of various anastomosis methods were analyzed in this article.

Key words：Laparoscopy；Gastric carcinoma；uncut roux-en-Y anastomosis；Gastrointestinal reconstruction

胃癌（gastric carcinoma）是常見的惡性腫瘤之一，根據中國癌癥中心公布的數據[1]，2013年我國胃癌的病死例數在惡性腫瘤病死例數中排到第3位。胃癌以腺癌多見，早期癥狀多不明顯，我國大部分胃癌患者發現病情時多已為進展期胃癌，且其中以遠端胃癌為主，目前腹腔鏡遠端胃癌根治術D2已經成為早期胃癌和進展期胃癌的成熟術式[2]。依據美國一項大宗病例報道，胃癌術后患者的5年生存率只有19%[3]。對于進展期胃癌，即使行手術治療，仍有較高的復發率，總體預后較差[4]。因此，患者術后的生活質量日益受到關注。術后患者的生活質量主要與手術的吻合方式有關，消化道重建方式已經超過70種，但其中常用的重建方式主要包括Brillroth Ⅰ三角吻合、Brillroth Ⅱ吻合、改良Brillroth Ⅱ吻合、Roux-en-Y吻合及逐漸受關注的uncut Roux-en-Y吻合，現就這4種吻合方式優缺點進行綜述。……