荷包包埋法在胃癌根治术十二指肠残端处理中的临床意义  

Clinical application of pocks embedding in duodenal stump closure after radical gastrectomy for gastric carcinoma

作　　者：赵忠扩[1] 邵钦树[1] 王永向[1] 叶再元[1] 徐继[1] 

机构地区：[1]浙江省人民医院胃肠外科,杭州310014

出　　处：《中华医学杂志》2011年第21期1475-1478,共4页National Medical Journal of China

摘　　要：目的评价荷包包埋法在胃癌根治术十二指肠残端处理中的临床应用价值。方法回顾性分析1995年1月至2009年12月浙江省人民医院2034例因胃癌行全胃切除或胃次全切除术患者的临床资料，十二指肠残端行荷包包埋（A组）465例，十二指肠残端行直线切割闭合器关闭＋浆肌层包埋（B组）835例，十二指肠残端行全层＋浆肌层包埋（C组）734例。对比分析各组手术费用、十二指肠残端处理时间、术后近期并发症、术中出血量、术后恢复情况。结果2034例患者术中无死亡，术后近期（1个月内）95例（4．7％）发生并发症，其中切口感染36例（37．9％），腹腔内出血18例（18．9％），吻合口漏14例（14．7％），3组之间差异均无统计学意义（均P〉0．05）。A组患者术后未发生十二指肠残端漏，与B组（6例，0．72％）和C组（5例，0．68％）比较，差异有统计学意义（P=0．048）。A组和C组的手术费用均显著低于B组[（9902±312）元和（9896±281）元比（13129±237）元，均P=0．0001]，A、c两组之间差异无统计学意义。A组和B组十二指肠残端处理时间均明显短于C组[（7．1±0．9）min和（7．6±0．8）min比（11．5±1．4）min，均P=0．0001]，A、B两组之间差异无统计学意义。3组术中出血量、术后恢复情况差异均无统计学意义（均／9〉0．05）。结论荷包包埋法处理十二指肠残端手术时间短，费用低廉，十二指肠残端漏发生率低，是胃癌手术十二指肠残端关闭的一种安全可靠、简单快捷的理想术式。Objective To explore the clinical effect of pockets embedding in duodenal stump closure after gastrectomy for gastric cancer. Methods A total of 2034 patients undergoing gastrectomy from January 1995 to December 2009 at our hospital were reviewed. Among them, Group A （ n = 465 ） underwent pockets embedding for duodenal stump, Group B （ n = 835 ） line-cutting stapler and hand-sewing while Group C （ n = 734 ） double layer hand-sewing. The operation cost, processing time of duodenal stump, recent post-operative complications （within 1 month）, blood loss volume and post-operative recovery status were compared between 3 groups. Results No patient died of operation. Ninety-five cases （4. 7% ） suffered recent post-operative complications. The most frequent complications included wound infection （36 cases, 37.9% ）, intra-abdominal hemorrhage （ 18 cases, 18.9% ） and anastomotic leakage （ 14 cases, 14. 7% ）. There was no significant difference in intra-abdominal bleeding, anastomotic leakage, abdominal infection, wound infection or duodenal stump leakage among 3 groups. There was no duodenal stump leakage in Group A. The difference was apparent in comparisons with Groups B （6 cases, 0. 72% ） and C （5 cases, 0. 68% ）. The operation costs of Groups A [ （9902±312） RMB] and C [ （9896±281 ） RMB] were significantly lower than that of Group B [ （ 13 129±237 ） RMB, P = 0. 0001 ]. And there was no difference between Groups A and C. The processing time of duodenal stump in Groups A [ （7. 1±0. 9） min] and B [ （7.6±0. 8） min ] were lower than that of Group C [ （ 11.5±1.4） min, P = 0. 0001 ]. And there was no difference between Groups A and B. There was no significant difference in blood loss volume or post- operative recovery status among 3 groups. Conclusion The post-gastrotomic closure of duodenal stump with pockets embedding for gastric cancer has a short operation time, a low operation cost and a low rate of duodenal stump leakage. It is a simple, prompt, promis

关 键 词：胃肿瘤 消化系统外科手术 手术后并发症 荷包包埋 

分 类 号：R735.2[医药卫生—肿瘤]