术中联合胃镜测漏对预防胃癌患者术后吻合口并发症的影响

Effect of routine leak testing in radical gastrectomy on prevention of postoperative anastomotic complication for patients with gastric cancer

摘要:

目的 对比术中联合胃镜的充气测漏和亚甲蓝测漏技术对胃癌根治术患者术后吻合口并发症的影响。方法 回顾性分析2017年9月－2019年9月南充市中心医院207例行胃癌根治术患者的临床和病理资料。根据是否使用术中测漏（IOLT），将患者分为IOLT组和无术中测漏（NIOLT）组。术中测漏包括胃镜检查、充气测漏和亚甲蓝测漏。分析术前、术中和术后的临床数据，如体重指数（BMI）、人口统计学、并发症和术中有无测漏等。对比两组患者术后吻合口瘘和吻合口出血等并发症发生情况。采用倾向评分匹配评价两组患者的基线资料后，两组患者各79例。结果 IOLT组有5例（6.3%）在手术过程中发现吻合口不连续，于术中行缝合修补；1例（1.3%）术后并发吻合口瘘。NIOLT组有7例（8.9%）术后并发吻合口瘘。NIOLT组吻合口瘘发生率高于IOLT组（P < 0.05）。IOLT组通过胃镜发现2例吻合口活动性出血，经缝合后成功止血。IOLT组平均手术时间较NIOLT组约长30 min（P < 0.05）。结论 术中联合胃镜充气测漏和亚甲蓝测漏技术可以有效减少术后吻合口瘘的发生，可将该技术应用于胃癌根治术中。

Abstract:

Objective To compare the effect of intraoperative air pressure and methylene blue leak testing combined with gastroscopy on anastomotic complications in patients underwent radical gastrectomy for gastric cancer.Methods This study retrospectively analyzed the clinical and pathological data of patients underwent radical gastrectomy for gastric cancer from September 2017 to September 2019. Patients were divided into intraoperative leak testing group (IOLT) and non-intraoperative leak testing group (NIOLT). Intraoperative leak testing includes air pressure and methylene blue leak testing combined with gastroscopy. Preoperative, intraoperative, and postoperative clinical data were analyzed [included body mass index (BMI), demographics, complications, and intraoperative leakage]. The incidence of postoperative complications such as anastomotic leak and anastomotic hemorrhage was compared between the two groups. After baseline data were evaluated by propensity score matching, 79 patients in each group were enrolled.Results 5 patients (6.3%) were found anastomotic discontinuity during the operation. We repaired the anastomotic discontinuity intraoperatively; 1 patient (1.3%) complicated with anastomotic leak in IOLT after operation. 7 patients (8.9%) complicated with anastomotic leak in NIOLT after operation. The incidence of anastomotic leak was higher in NIOLT than that in IOLT (P < 0.05). 2 patients were found to have active bleeding from the anastomosis through intraoperative gastroscopy. The bleeding was successfully stopped after additional suture in the anastomosis. The mean operation time of IOLT group was about 30 min longer than that of NIOLT group (P < 0.05).Conclusion We found that combining the technique of gastroscopy, air pressure and methylene blue in IOLT can effectively reduce the incidence of postoperative anastomotic leak. The technique of intraoperative leak testing combined with gastroscope is recommended in radical gastrectomy for gastric cancer.