腹腔镜下远端胃癌根治术Billroth Ⅱ式吻合不同吻合方式的疗效影响  

Laparoscopic distal gastrectomy using different kinds of Billroth Ⅱ anastomosis

作　　者：蒋雪峰[1,2] 肖宝来[1,2] 胡小苗[1,2] 岳信[1,2] 张义[1,2] 尹传昌[1,2] 邓清[1,2] 田夫[1,2] 

机构地区：[1]荆州市第一人民医院 [2]长江大学附属第一医院胃肠外科,湖北省434000

出　　处：《中华普外科手术学杂志（电子版）》2013年第4期31-34,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨使用不同的吻合器械行胃空肠吻合在腹腔镜下胃远端癌根治术中的临床疗效。方法回顾性分析2006年6月至2011年9月间实施的205例腹腔镜下胃远端癌根治术并BillrothⅡ式胃空肠吻合病例的临床资料。胃空肠吻合分别采用切割闭合器(102例)和圆形吻合器(103例)完成。应用Spss17.0统计软件进行分析,两组术中和术后数据以x珋±s表示,采用t检验;两组并发症发生率组间比较采用χ2检验或Fisher确切概率法。结果 205例患者均成功施行腹腔镜下胃远端癌淋巴结清扫及胃空肠吻合。切割闭合器组和圆形吻合器组术后并发症总发生率分别为10.8%(11/102)和12.6(13/103)(χ2=0.683,P>0.05),两组在肠梗阻、腹腔内出血、吻合口梗阻、吻合口漏、吻合口出血、胃排空障碍、反流性食管炎、后期倾倒综合征并发症的发生率差异无统计学意义;两组患者总手术时间分别为(240.3±89.2)min和(245.5±82.1)min;术中出血量分别为(158.2±28.4)ml和(156.6±30.4)ml;术后下床时间分别为(1.8±1.6)d和(1.8±1.4)d;肛门恢复通气时间分别为(2.8±1.4)d和(2.9±1.3)d;进半流食时间分别为(3.6±0.8)d和(3.6±1.2)d;术后住院时间分别为(7.9±2.3)d和(8.0±2.1)d;住院费用分别为(35153.2±10163.0)元和(33103.0±10125.1)元,两组差异均无统计学意义(P>0.05)。结论腹腔镜下胃远端癌根治术采用切割闭合器和圆形吻合器行胃空肠吻合手术,两种吻合方式具有相同的安全性和相似的疗效。Objective To investigate the clinical efficacy of laparoscopic distal gastrectomy by using different anastomosis instrument for gastrointestinal anastomosis. Methods From June 2006 to September 2011, a retrospective analysis was performed in 205 patients with distal gastric cancer who underwernt laparoscopic distal gastrectomy and Billroth Ⅱ anastomosis in the department of gastrointestinal surgery. Stomach-jejunum anastomosis was made using a line-cutting closer in 102 patients and using a circular stapler in 103 patients. Statistical software SPSS 17.0 was used for data analysis. Intraoperative and postoperative data of the two groups were expressed as X ± SD, and were compared using Student ＇s t test. Postoperative complications were compared by the Chi-square test or Fisherg exact test between the two group. Results 205 patients underwent laparoscopic distal gastrectomy with Billroth H anastomosis. The overall incidence rate of complications in the line-cutting closer group and circular stapler group was 10. 8% （11/102） and 12.6 （13/103） respectively, （χ^2 =0. 683, P 〉 0. 05 ）. The incidences of intestinal obstruction, abdominal cavity hemorrhage, anastomotic obstruction, anastomotic fistula, anastomotic bleeding, gastric emptying disorder, reflux esophagitis and late dumping syndrome were not significantly different between the two groups. Postoperative hospital stay was（ 7.9 ±2.3 ）and （8.0 ±2.1） days respectively. Conclusion Laparoscopic distal gastrectomy using a line-cutting closer or a circular stapler could gain similar efficacy and safety.

关 键 词：胃肿瘤 腹腔镜检查 胃切除术 

分 类 号：R735.2[医药卫生—肿瘤]