H形吻合在腹腔镜下远端胃癌根治术中的应用  

Application of H reconstruction in laparoscopic distal gastrectomy for gastric cancer

作　　者：李军辉[1] 曹罡[1] 张焱[1] 张莉[1] 杨荔[1] 杨文彬[1] LI Jun-hui CAO Gang ZHANG Yan et al(Department of General Surgery, Second Affiliated Hospital, Xi＇an Jiaotong University, Xi＇an 710004, China)

机构地区：[1]西安交通大学第二附属医院,陕西西安710004

出　　处：《腹腔镜外科杂志》2016年第10期729-732,共4页Journal of Laparoscopic Surgery

基　　金：国家自然科学基金(编号:81472246);陕西省自然科学基础研究计划项目(编号:S2013JC10182)

摘　　要：目的:评价H形吻合在腹腔镜下远端胃癌根治术后消化道重建中的临床效果。方法:回顾分析2013年1月至2015年6月152例行腹腔镜下远端胃癌根治术且有完整随访资料患者的临床资料,根据其消化道重建方式分为:H形吻合组(n=20)、毕Ⅰ式吻合组(n=53)、毕Ⅱ式吻合组(n=58)及Roux-en-Y吻合组(n=21)。4组患者在年龄、性别、肿瘤大小、肿瘤分期及分级方面差异均无统计学意义。结果:H形吻合组手术时间及重建时间较毕Ⅰ式有所增加,且重建时间两者差异有统计学意义,与毕Ⅱ式吻合组差异无统计学意义,较Roux-en-Y吻合组明显缩短,差异有统计学意义;H形吻合组术中出血量少于毕Ⅰ式吻合组,差异有统计学意义。术后每日胃肠减压量、术后进流质饮食时间明显少于其他三组,差异有统计学意义。H形吻合组术后排气时间明显缩短,与Roux组相比差异有统计学意义。H形吻合组无术后吻合口狭窄、出血、吻合口漏等并发症发生。结论:H形吻合能明显降低手术时间,减少术后排气时间、胃潴留、吻合口梗阻等并发症,是远端胃癌根治术后理想的消化道重建方式。Objective： To evaluate the clinical efficacy of H reconstruction in digestive tract reconstruction after laparoscopic distal gastrectomy for gastric cancer. Methods： Clinical data of 152 patients who underwent laparoscopic distal gastrectomy for gastric cancer with complete follow-up data between Jan. 2013 and Jun. 2015 were retrospectively analyzed. Patients were divided into H group（ 20 cases with H reconstruction）,BⅠ group（ 53 cases with BillrothⅠ reconstruction）,BⅡ group（ 58 cases with modified Billroth Ⅱreconstruction） and Roux-en-Y group（ 21 cases with Roux-en-Y reconstruction） according to reconstructive methods. The differences of age,sex,size,stage and grade of tumors in the four groups were not statistically significant. Results： The reconstruction time in the H group was longer than that in the BⅠ group,shorter than that in the Roux-en-Y group with statistically significant difference,and the difference was not statistically significant compared with the B Ⅱ group. The intraoperative blood loss in the H group was less than that in the BⅠ group. There were fewer gastrointestinal drainage per day and the shorter time to eat liquid diet in the H group compared with those in the other three groups with statistically significant difference. The time of postoperative exhaust was shorter in the H group than that in the Roux-en-Y group. No complications occurred such as anastomotic stenosis,bleeding or leakage in the H group. Conclusions：The H reconstruction can reduce the time of operation,postoperative exhaust time,complications such as gastric retention and anastomotic obstruction. It may be the preferred technique for reconstruction after laparoscopic distal gastrectomy of gastric cancer.

关 键 词：胃肿瘤 远端 胃癌根治术 腹腔镜检查 消化道重建 H形吻合 

分 类 号：R735.2[医药卫生—肿瘤]