| Objective: Gastric cancer is a common malignant tumor of the digestive tract in China.Lower gastric cancer accounts for a considerable proportion of patients with gastric cancer in China and the standard surgical procedure is radical distal gastrectomy.Since entering the 21 st century,laparoscopic minimally invasive technique and gastrointestinal mechanical anastomosis have developed rapidly and are widely used in clinical practice.Although the basic working principles of different types of staplers are the same,their anastomosis clinical features are different.The purpose of this study was to explore the safety and health economics differences between a linear-cut stapler and a circular stapler in Roux-en-Y reconstruction after laparoscopic-assisted distal gastrectomy.Methods: Clinical data of 192 gastric cancer patients who received laparoscopic-assisted distal gastrectomy with Roux-en-Y reconstruction from August 2017 to February 2019 at Department of gastrointestinal Surgery of Hospital Affiliated Qingdao University has been collected and analyzed retrospectively.According to the type of anastomosis equipment used in gastrojejunostomy,patients were divided into linear stapler group(LS)and circular stapler group(CS).The differences between the two groups in terms of surgical safety,postoperative gastrointestinal function recovery,and health economic indicators were compared and analyzed.Results: Forty patients(20.8%)were in linear stapler group and one hundred and fifty-two patients(79.2%)were in circular stapler group.There were no significant differences between linear stapler group and circular stapler group in mean age(59.58±9.55 years vs.59.88±8.92 years,P =0.852),gender(male /female,30/ 10 vs.119/33,P=0.657),Body mass index(median: 23.7 kg/m2 vs.24.0 kg/m2,P =0.062),median tumor diameter in long axis(4.0 cm vs.3.5 cm,P =0.766),median tumor diameter in short axis(2.75 cm vs.2.95 cm,P =0.903),pathological TNM stage(Ⅰ/Ⅱ/Ⅲ,11/ 13/16 vs.69/39/44,P=0.121)(all P>0.05).There were no significant differences between two groups in mean intraoperative blood loss [(59.75±38.397)ml vs.(63.29±67.792)ml,P=0.752)],mean operating time [(249.28±65.72)min vs.(255.03±62.67)min,P=0.609],total retrieved lymph nodes [(30.68±11.74)vs.(32.43±12.61),P=0.429],II degree and above morbidity of postoperative complication [7.5%(3/40)vs.7.9%(12/152),P=1.000]、median cost of surgical consumables(median number:30758 yuan vs.32749 yuan,P=0.064)and median hospitalization costs(median number:70759 yuan 比 70851 yuan,P=0.527).However,the mean time to the first flatus [(3.46±0.767)d vs.(3.98±1.190)d,P=0.013]、the mean time to the first intake of liquid diet [(4.32±1.029)d vs.(4.91±0.996)d,P=0.020]and the mean time to remove the abdominal drainage tube [(6.00±0.882)d vs.(6.56±1.764)d,P=0.008] of the patients in linear stapler group were shorter than that in circular stapler group.Conclusions: There were no significant differences between linear stapler and circular stapler in terms of intraoperative conditions,incidence of postoperative complications,and health economic indicators.They both are safe and feasible in Roux-en-Y reconstruction after laparoscopic-assisted distal gastrectomy.However,compared with the circular stapler,the advantage is obvious with linear stapler in sooner first flatus,sooner first intake of liquid diet,and quicker postoperative recovery of gastrointestinal function.The surgeon can choose the appropriate anastomosis device according to the characteristics of different staplers and the specific tumor specificity of the patient,so that the patient can fully benefit. |
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