Comparison Of Safety Of Total Laparoscopic Total Gastrectomy With Functional End-to-end Anastomosis And Laparoscopic Assisted Total Gastrectomy

Objective The clinical feasibility and safety of total laparoscopic total gastrectomy for functional end-to-end anastomosis of esophagus and jejunum and laparoscopic-assisted total gastrectomy for functional end-to-end anastomosis of esophagus and jejunum were further confirmed by comparing and analyzing the therapeutic effects and postoperative rehabilitation of patients with gastric cancer with two surgical methods of total laparoscopic total gastrectomy for functional end-to-end anastomosis of esophagus and jejunum.To fully understand and master the basis of total laparoscopic gastrectomy,and to provide scientific data and theoretical basis for further research,and better guide clinical work.Methods This study collected 92 patients who underwent laparoscopic radical gastrectomy in the first affiliated hospital of fujian medical university from January 2017 to December 2018.Patients receiving total laparoscopic gastrectomy were assigned to the total laparoscopic group(n=43),and patients receiving laparoscopic assisted total gastrectomy were assigned to the total laparoscopic group(n=49).The basic conditions,intraoperative conditions,postoperative recovery and complications of the two groups of patients were retrospectively compared,so as to compare the advantages and disadvantages of the two surgical methods,and to compare and discuss with domestic and foreign literatures.Result Baseline data:there were no significant differences in age,sex ratio,BMI,ASA grades between the two groups(P>0.05).Intraoperative assessment:intraoperative blood loss and maximum incision length in the total laparoscopic group were smaller than those in the laparoscopic auxiliary group,and the difference was statistically significant(P<0.05).The total operation time and digestive tract reconstruction time of the total laparoscopic group were greater than those of the laparoscopic-assisted group,and the differences were statistically significant(P<0.05).The total number of lymph nodes dissected by surgical methods in the two groups was not statistically significant(P>0.05),and the tumor resection margin was all R0 resection.Postoperative recovery indexes: postoperative exhaust time,time of getting out of bed,time of fluid diet,time of semi-fluid diet and overall hospitalization time in the total laparoscopic group were all lower than those in the laparoscope-assisted group,with statistically significant differences(P<0.05).Postoperative complications: no incision infection was found in the whole laparoscopic group,and 4 cases were found in the laparoscopic auxiliary,the difference was statistically significant(P<0.05).There was no significant difference in the number of postoperative pulmonary infection,anastomotic fistula,anastomotic stenosis,anastomotic bleeding,intestinal obstruction and abdominal infection between the total laparoscopic group and the laparoscopic auxiliary group(P>0.05).No death occurred within 30 days after surgery in both groups.Conclusion This paper argues that total laparoscopic total gastrectomy by functional end to end anastomosis of esophagus jejunum compared with laparoscopic assisted total gastrectomy,surgical trauma resulting from smaller,there was no significant difference between operation difficulty and safety,and the effect of postoperative treatment and early postoperative rehabilitation is superior to the laparoscopic assisted total gastrectomy,worthy of clinical popularization and application...