超长鼠齿钳联合推结器在腹腔镜辅助小切口食道-空肠吻合术中的应用  

The application of the overlong rat-tooth forceps combined with knot pusher in the use of the esophagojejunal anastomosis by smaller incision assisted with laparoscopy

作　　者：解曙哲[1] 连长红[1] 赵强[1] 韩超[1] 宋应明[1] 张慧清[1] 

机构地区：[1]长治医学院附属和平医院普通外科,046000

出　　处：《中华普外科手术学杂志（电子版）》2016年第4期324-327,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的 超长鼠齿钳联合推结器在腹腔镜辅助小切口食道-空肠吻合术中的应用,探讨其可行性、安全性及临床效果。方法 回顾性分析2009年7月至2014年3月308例Ⅱ、Ⅲ型食管胃结合部癌患者临床资料,其中100例患者常规取上腹部正中切口（7~15 cm）完成吻合（常规切口组）,208例患者在上腹正中取小切口（4~7 cm,小切口组）,采用SPSS17.0软件进行统计学分析,两组手术时间、手术切口长度、放置抵钉座时间、术后吗啡用量、术后住院时间等用均数±标准差（x珋±s）表示,采用t检验;术后并发症比较采用校正χ2检验,P〈0.05为差异具有统计学意义。结果 308例患者均在腔镜下完成手术,小切口组在切口长度（t=6.181,P〈0.05）,、抵钉座放置时间（t=5.825,P〈0.05）、术后吗啡的使用量上（t=10.660,P〈0.05）明显优于常规切口组,两者差异具有统计学意义（P〈0.05）;两者的手术时间及术后住院时间差异无统计学意义（P〉0.05）;两组的术后总并发症发生率：小切口组为1.4%（3/208）,常规切口组为9.0%（9/100）,差异具有统计学意义（χ2=8.382,P〈0.05）;两组均无死亡病例。结论 利用超长鼠齿钳联合推结器放置抵钉座更变捷、微创和安全,可以缩短手术时间、缩小切口长度及预防术后吻合口漏的发生。[Abstrat] Objective To explore the feasibility ,safety and clinical efficacy of the overlong rat-tooth forceps combined with knot pusher in the use of the esophagojejunal anastomosis by smaller incision assisted with laparoscopy . Methods From July 2009 to March 2014, 308 patients with type Ⅱ or type Ⅲesophagogastric junction cancer who were treated with radical tatal gastrectomy were analyzed retrospectively , in which the esophagojejunal anastomoses were taken by epigastric incision .Esophagojejunal anastomoses continued after the stomachs were dissociated and the lymph nodes were removed .100 patients were taken upper abdomen midline incision （7-15 cm, the conventional incision group ） routinely while 208 patients were taken smaller upper abdomen midline incision （4-7 cm, the smaller incision group ） with disposable incision open holder to show the operation field .To analyse the data with SPSS17.0 software.Measurement data in 2 groups, including operation time , the length of the insision , the time to place the anvil , the dosage of morphine after operation , postoperative hospital stay were expressed as x珋＆#177;s, and were compared with t test, the count data of the incidence of complications after operation were compared by the Continuity Correction.P ＆lt;0.05 was considered as statistical significance . Results All the 308 patients were operated by laparoscopy ,the smaller incision group had more advantages than the conventional incision group in the length of the insision （t=6.181, P＆lt;0.05）, the time to place the anvil （t=5.825, P＆lt;0.05）, the dosage of morphine after operation （t=10.660, P＆lt;0.05）, the differences in the operation time and the postoperative hospital day were no statistically significant between the two groups （P＆gt;0.05）.As for the whole complications rate after operation between the two groups： the smaller incision group was 1.4% 〈br〉 （3/208） when the conventional incision group 9.0%（9/100）, there was statistically significan

关 键 词：食管胃结合处 吻合术 Roux-en-Y 腹腔镜检查 外科缝合器缝合 

分 类 号：R656[医药卫生—外科学]