Application Of Total Laparoscopic Delta-shaped Anastomosis In Radical Gastrectomy For Distal Gastric Cancer

Purpose:We comparative analyze the clinical effect of total laparoscopic delta-shaped anastomosis and laparoscopically assisted Billroth-I anastomosis in radical gastrectomy for distal gastric cancer,and the feasibility of total laparoscopic delta-shaped anastomosis in radical gastrectomy for distal gastric cancer.Method:The clinical data of 46 patients with laparoscopic radical gastrectomy who met the inclusion criteria between August 2016 and December 2018 in the China Japan Union Hospital were analyzed(21 patients underwent total laparoscopic delta-shaped anastomosis and 25 patients underwent laparoscopically assisted Billroth-I anastomosis).We have compared the operation time and intraoperative time of the two groups;the amount of bleeding,the length of the auxiliary incision,the number of Lymph nodes;postoperative complications,the incidence of anastomotic leakage,anastomotic bleeding,and auxiliary incision infection;general postoperative conditions,including postoperative analgesics doses,anal exhaust time,length of hospital stay,hospitalization expenses and other indicators were statistically analyzed using SPSS 22.0 software to evaluate the difference in clinical effects between the two anastomotic methods in radical gastrectomy.Result:1.The total laparoscopic delta-shaped anastomosis group and the laparoscopically assisted Billroth-I anastomosis group were compared in general data such as gender,age,history of hypertension,smoking history,and drinking history but the difference was not statistically significant(P> 0.05).(Table 1)2.The operation time of the laparoscopic delta-shaped anastomosis group was significantly longer than that of the laparoscopically assisted Billroth-I anastomosis group [(226.6±36.5)min vs(202.1±34.8)min,P<0.05].The bleeding in the laparoscopic delta-shaped anastomosis group was significantly less than that in the laparoscopically assisted Billroth-I anastomosis group [(106.7±25.4)ml vs(129.6±39.3)ml,P<0.05].The length of the auxiliary incision in the laparoscopic delta-shaped anastomosis group was significantly shorter than that in the laparoscopically assisted Billroth-I anastomosis group [(4.9 ± 0.9)cm vs(9.7 ± 1.2)cm,P < 0.05].The use of analgesics after laparoscopic delta-shaped anastomosis was significantly less than that of laparoscopically assisted Billroth-I anastomosis[(87.6±53.1)mg vs(202.1±41.1)mg,P<0.05].The anus exhaust time of the laparoscopic delta-shaped anastomosis group was significantly shorter than that of the laparoscopically assisted Billroth-I anastomosis group [(2.6 ± 0.6)d vs(3.1 ± 0.5)d,P < 0.05].The number of hospital stays in the laparoscopic delta-shaped anastomosis group was significantly less than that in the laparoscopically assisted Billroth-I anastomosis group [(9.8 ± 1.4)d vs(11.4 ± 1.9)d,P < 0.05].The hospitalization cost of the laparoscopic delta-shaped anastomosis group was significantly higher than that of the laparoscopically assisted Billroth-I anastomosis group [(100.9±5)thousand yuan vs(80.4±7)thousand yuan,P<0.05].The difference between total laparoscopic delta-shaped anastomosis group and laparoscopically assisted Billroth-I anastomosis group in operation time,intraoperative blood loss,length of auxiliary incision,postoperative analgesic dose,anal exhaust time,hospital stay,hospitalization cost has statistically significant meaning.3.Total complication rate between the laparoscopic delta-shaped anastomosis group and the laparoscopically assisted Billroth-I anastomosis group(there were no significant differences in anastomotic leakage,anastomotic bleeding,and wound infection.),including the number of Lymph nodes.There was no significant difference in that(P>0.05).Conclusion:1.Compared with laparoscopically assisted Billroth-I anastomosis,laparoscopic delta-shaped anastomosis has the advantages of less trauma,less intraoperative blood loss,less auxiliary incision,less postoperative pain and quick recovery.2.There was no significant difference in the incidence of postoperative complications between laparoscopic delta-shaped anastomosis and laparoscopically assisted Billroth-I anastomosis in radical gastrectomy.3.Total laparoscopic delta-shaped anastomosis requires higher surgical costs than laparoscopically assisted Billroth-I anastomosis,but it is worthy of application and promotion if patients could afford.