国产吻合器及缝合器在BillrothⅡ式胃肠吻合加Braun吻合术中的使用方法及顺序改进  

Application of Domestic Produced Staplers and Stitch Instruments on Billroth's Ⅱ Gastrojejunostomy and Braun's Anastomosis with A Modification Process

作　　者：吕德泉[1] 张始业[1] 王春祥[1] 孙孝东[1] 

机构地区：[1]山东省济南市第三人民医院普外科,济南250101

出　　处：《中国现代手术学杂志》2006年第6期420-422,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨国产GF-Ⅱ型管状吻合器及XF-Ⅱ型缝合器在BillrothⅡ式胃肠吻合加Braun吻合术中的使用效果。方法采用GF-Ⅱ型管状吻合器及XF-Ⅱ型缝合器行胃大部切除术后上消化道重建158例，其中十二指肠残端器械缝合130例，手工缝合25例，十二指肠残端置蕈状管引流3例，胃空肠器械吻合158例，Braun器械吻合150例，胃残端器械缝合155例，手工缝合3例。吻合顺序依次为十二指肠残端缝合Braun吻合、胃空肠吻合、胃残端缝合。结果平均15（9～22）min内完成消化道重建，术后胃肠器械吻合处发生吻合口出血3例，2例经保守治疗治愈，1例再手术止血；排空障碍1例，治疗20d后治愈。术后有25例接受胃镜检查，未发现胆汁反流者。结论严格按照操作规程操作，使用顺序得当，应用国产GF型管状吻合器及XF型缝合器能显著缩短手术时间，效果良好，安全性高。Objective To investigate the effect of domestic produced staplers and stitch instruments on Billroth＇s Ⅱ gastrojejunostomy and Braun＇s anastomosis. Method 158 cases of subtotal gastrectomy underwent upper gastrointestinal reconstruction with GF staplers and XF stitch instruments. The duodenal stumps were dosed with instruments： in 130 cases, hand-sewing in 25 cases and mushroom tube drainage in 3 cases. The gastrojejunostomies were conducted with instruments in 158 cases, the Braun＇s anastomosis were done with instruments in 150 cases, gastric stumps were closed in 155 cases with instruments, 3 cases with hand-sewing. The procedures were performed in the order from first to last as duodenal stump close, Braun＇s anastomosis, gastrojejunostomy and gastric stump close. Result The reconstructions were completed in 15 （9 -22） minutes, there were 3 cases of anastomotic hemorrhage in which 2 cases were cured by conservative treatment and 1 underwent reoperation. Gastric emptying dysfunction occurred in 1 case which was cured conservatively. In 25 cases received gastroscopy, there was no bile reflux presented. Conclusion Domestic produced staplers and stitch instruments on Billroth＇s Ⅱ gastrojejunostomy and Braun＇s anastomosis is safe and recommendable.

关 键 词：胃肠吻合术 吻合器 缝合器 

分 类 号：R656.6[医药卫生—外科学] R735.2[医药卫生—临床医学]