胃癌全胃切除手法和吻合器缝合的比较  

Comparative analysis of manual and stapler anastomoses after total gastrectomy for gastric cancer

作　　者：詹文华[1] 何裕隆[1] 郑章清[1] 陈正煊[1] 汪建平[1] 黄奕华[1] 王吉甫[1] 

机构地区：[1]中山医科大学附属第一医院胃肠胰外科,广州510080

出　　处：《中华胃肠外科杂志》2001年第1期18-21,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：中山医科大学"211工程"重点学科建设项目基金(98097)

摘　　要：目的 比较胃癌全胃切除术手法和机械重建消化道的手术时间、输血量、并发症及死亡率。方法 １９９３年１月至２０００年１２月我科共施行胃癌全胃切除术１４０例，按手法吻合和吻合器吻合重建消化道分为两组，手法吻合组５３例，吻合器吻合组８７例。两组的肿瘤部位、分期无明显差别。结果 手法组输血量为（４４３±４３２）ｍｌ，器械组为（４３０±４３５）耐（Ｐ＞０．０５）。手法组手术时间为（２５４±９５）ｍｉｎ，器械组为（２１１±５７）ｍｉｎ（Ｐ＜０．０５）。肺部感染手法组６例，器械组８例。切口感染手法组１例，器械组２例。吻合口狭窄两组各１例，吻合口瘘和术后出血手法组分别为２例和１例，器械组无吻合口痰和术后出血。手法组死亡１例，器械组无死亡。结论吻合器吻合重建消化道能节约手术时间，减少总手术并发症。Objective To compare the operating duration, the volume of blood transfusion, morbidity and mortality in gastrointestinal reconstruction after total gastrectomy for gastric cancer between manual and stapler anastomosis. Methods From January 1993 to December 2000, 140 patients underwent total gastrectomy for gastric cancer. The patients were divided into two groups according to the method of gastrointestinal reconstruction. There were 53 patients in group A in which anastomosis was performed with manual procedure and 87 patients in group B with stapler. There was no significant difference in the location and clinical stage of the carcinoma between the two groups. Results The mean volume of blood transfusion was (443 ± 432) ml in group A and (430 ± 435) ml in group B( P> 0.05) . The mean operating duration was (254±98)minutes in group A and (211 ± 87)minutes in group B respectively( P < 0. 05) . Pulmonary injection and incision injection occurred in 6 and 1 patients respectively in group A, whereas 8 and 2 patients respectively in group B. Anastomotic stenosis occurred in 1 patient in both groups. Two patients were complicated with leakage, I with postoperative bleeding and 1 died in group A, but no such complications were found and none died in group B. Conclusion For gastrointestinal reconstruction, the use of stapler can shorten the operating duration and reduce overall morbidity.

关 键 词：胃肿瘤 吻合器 全胃切除 胃癌 消化道重建 

分 类 号：R735.2[医药卫生—肿瘤] R730.56[医药卫生—临床医学]