胃十二指肠三角吻合术在远端胃癌根治术后消化道重建中的安全性及疗效观察  

Safety and Efficacy of Gastroduodenal Triangular Anastomosis in Digestive Tract Reconstruction after Radical Gastrectomy

作　　者：丁海涛[1] 韩智君[1] 曹杰[1] 迪米拉[1] 帕尔哈提.阿布都热衣木 

机构地区：[1]新疆医科大学第六附属医院普外科,乌鲁木齐830063

出　　处：《中国现代手术学杂志》2017年第3期182-186,共5页Chinese Journal of Modern Operative Surgery

基　　金：新疆维吾尔自治区自然科学基金资助项目(2016D01C217)

摘　　要：目的探讨胃十二指肠三角吻合术在远端胃癌根治术后消化道重建中的安全性及效果。方法选取2015年1月至2015年12月本院收治的204例胃癌患者,根据随机数字表法将患者随机分为观察组和对照组,观察组100例,予以全腹腔镜下远端胃癌根治胃十二指肠三角吻合术,对照组104例,予以腹腔镜BillrothⅠ吻合术,比较两组患者的术中出血量、手术时间、淋巴结清扫数量、首次肛门排气时间、恢复饮水时间、流质饮食时间、术后住院时间;随访6个月,比较两组患者的血液营养学指标及并发症发生率。结果观察组患者术中出血量显著少于对照组,手术时间显著短于对照组(P<0.05)。观察组及对照组的淋巴结清扫数量比较,差异无统计学意义(P>0.05)。观察组患者首次肛门排气时间、恢复饮水时间、恢复流质饮食时间、术后住院时间均显著短于对照组(P<0.05)。随访6个月,观察组血红蛋白、前白蛋白、血浆总蛋白水平均显著高于对照组(P<0.05)。观察组术后总并发症发生率为8%(8/100),对照组术后总并发症发生率为9.62%(10/104),经χ~2检验,两组术后并发症发生率比较无显著差异(χ~2=0.743,P=0.102)。结论胃十二指肠三角吻合术具有出血少、创伤小、恢复快等优点,可有效促进远端胃癌根治术后患者营养状况的恢复,减少术后并发症,是胃癌患者比较理想的消化道重建手术方法。Objective To investigate the safety and effect of gastroduodenal triangular anastomosis in digestive tract reconstruction after radical gastrectomy.Methods From January 2015 to December 2015,204 patients with gastric cancer were randomly divided into the observation group and the control group according to the random number table.The observation group was treated with laparoscopic gastroduodenal triangular anastomosis in digestive tract reconstruction after radical gastrectomy.And the control group was treated with laparoscopic Billroth Ⅰ gastroduodenal anastomosis.Results Blood loss in the observation group was significantly less than that in the control group.Operation time was significantly shorter than that of the control group （P ＜ 0.05）.There was no significant difference in lymph node dissection between the observation group and the control group （P ＞ 0.05）.The interval of the first anal exhaust,water and fluid diet and postoperative hospital stay was significantly shorter in the observation group （P ＜ 0.05）.The levels of hemoglobin,prealbumin and plasma total protein in the observation group were significantly higher than that of the control group （P ＜0.05）.The incidence of total complication of the observation group and the control group was 8％ （8/100） and 9.62％ （10/104） respectively.There was no significant difference between the two groups （x2 =0.743,P =0.102）.Conclusion Gastrduodenal triangular anastomosis has the advantages of less bleeding,less trauma and quicker recovery,which can effectively promote the recovery of nutritional status of patients with distal gastric cancer and reduce the postoperative complications.It is an ideal digestion reconstruction method for gastric cancer patients.

关 键 词：胃肿瘤 腹腔镜检查 消化道重建 胃十二指肠三角吻合 远端胃癌切除术 

分 类 号：R735.2[医药卫生—肿瘤]