Clinical Application Value Of Improved Reverse Puncture Technique In Totally Laparoscopic Total Gastrectomy

Objiective: To investigate the feasibility,safety and short-term clinical effect of improved reverse puncture technique in total laparoscopic total gastrectomy.Methods: A retrospective analysis of the clinical data of 120 patients with upper gastric cancer who undergoing laparoscopic total gastrectomy in the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Wannan Medical University from September 2018 to March 2020.Among them,80 patients underwent TLTG.According to different methods of esophagojejunal anastomosis,they were divided into improved reverse puncture group(n=43)and Overlap group(n=37).Another 40 patients underwent laparoscopic assisted total gastrectomy(LATG group,n=40).Compare the differences between the improved reverse puncture group and the other two groups in intraoperative and postoperative outcomes.Results: The preoperative general clinical data of the three groups were comparable.Compared with the LATG group,the anastomosis time and operation time in the improved reverse puncture group were prolonged(both P < 0.05),but the incision length[(3.7±0.4 vs 10.2±1.1)cm],intraoperative blood loss[(82.4±42.7 vs 143.6±35.2)ml],postoperative 24 h visual analog score of pain(2.47±0.98 vs 4.40±1.37),first ventilation time[(3.2±0.9 vs 4.1±0.8)d],gastric tube removal time [(6.3±1.3 vs 7.2±0.9)d],drainage tube removal time[(7.5±1.3 vs 10.9±2.2)d] and length of hospital stay[(9.4±1.4 vs12.7±2.2)d] were better than those in the LATG group(all P < 0.05).There were no significant differences between the two groups in the length of the resected esophagus,the number of lymph nodes dissected and and the inflammatory indexes on the first and seventh days after surgery(all P > 0.05).Compared with Overlap group,the anastomosis time and resection esophagus length in the improved reverse puncture group were shorter[(46.1±4.79 vs 52.8±4.9)min],[(4.1±0.6 vs 5.6±0.8)cm;P < 0.05)];There were no statistically significant differences in other observation indicators between the two groups(P > 0.05).There was no significant differences in postoperative complications among the three groups(P > 0.05).Conclusion: Improved reverse puncture technique is safe and feasible in total laparoscopic total gastrectomy,the clinical effect is better than laparoscopic-assisted total gastrectomy,and the anastomosis time is shorter than Overlap method,and the short-term effect is similar,so it has certain clinical application value.