Delta-shaped术和Billroth Ⅰ术在腹腔镜远端胃癌根治术中的应用效果  

Delta-shaped surgery and Billroth Ⅰ in the radical operation of laparoscopic distal gastric cancer

作　　者：李锋[1] 彭德伟[1] 王梦桥[1] 李文艺[1] 邹燕蕾[1] 周礼[1] LI Feng;PENG Dewei;WANG Mengqiao;LI Wenyi;ZOU Yanlei;ZHOU Li(Department of General Surgery,Chengdu Fifth People's Hospital,Chengdu 611130,China)

机构地区：[1]成都市第五人民医院普外科,四川成都611130

出　　处：《西部医学》2020年第3期452-455,共4页Medical Journal of West China

基　　金：四川省医学会科研课题(Q18064)。

摘　　要：目的对比远端胃癌根治手术中实施全腹腔镜下三角吻合术(Delta-shaped)和腹腔镜辅助下毕Ⅰ式吻合术(Billroth Ⅰ)应用效果。方法回顾性分析我院2015年5月~2018年5月实施腹腔镜远端胃癌根治术患者115例,根据手术方式依次分为Delta-shaped术组(33例)和Billroth Ⅰ术组(82例)。两组均实施淋巴结清扫术,其中Delta-shaped术组实施Delta-shaped术,Billroth Ⅰ术组实施Billroth Ⅰ术。观察两组患者术中指标、组织标本情况、术后恢复情况,并统计术后并发症发生率。结果两组患者吻合时间比较差异无统计学意义(P>0.05);Delta-shaped术组初始手术时长长于Billroth Ⅰ术组(P<0.05);Delta-shaped术组学习曲线后手术时长、术中出血量均短于Billroth Ⅰ术组(P<0.05)。两组患者肿瘤大小、淋巴结清扫个数相当(P>0.05);Delta-shaped术组切口长度、切缘距离均低于Billroth Ⅰ术组(P<0.05)。Delta-shaped术组术后镇痛时间、首次通气时间、胃肠功能恢复时间、下地时间、拆线时间、住院时间均短于Billroth Ⅰ术组(P<0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论腹腔镜远端胃癌根治手术中实施Delta-shaped术近期优势高于BillrothⅠ术,其手术创伤相对较小,术后恢复较快,临床应用价值较高。Objective To study the application effects of total laparoscopic Delta-shaped anastomosis(Deltashaped)and laparoscopic assisted Billroth Ⅰ anastomosis(Billroth Ⅰ)in the radical operation of distal gastric cancer.Methods A retrospective analysis was performed on 115 patients with radical operation of laparoscopic distal gastric cancer from May 2015 to May 2018 in our hospital.They were divided into Delta-shaped group(33 cases)and Billroth Ⅰ group(82 cases)according to the surgical procedures.The two groups were given lymph node dissection.Delta-shaped group was given Delta-shaped surgery.Billroth Ⅰ group was given Billroth Ⅰ surgery.The intraoperative indexes,tissue specimens and postoperative recovery were observed in the two groups,and the incidence rate of postoperative complications was counted.Results The anastomosis time in the two groups was comparable(P>0.05),and the initial operation time in Delta-shaped group was longer than that in Billroth Ⅰ group(P<0.05).The operative time and intraoperative blood loss after learning curve in Delta-shaped group were shorter than those in Billroth Ⅰ group(P<0.05).The tumor size and lymph node dissection quantity were similar in the two groups(P>0.05),and the incision length and margin distance in Delta-shaped group were lower than those in Billroth Ⅰ group(P<0.05).The postoperative analgesia time,the first ventilation time,gastrointestinal function recovery time,ambulation time,suture removal time and hospital stay were shorter in Delta-shaped group than those in BillrothⅠgroup(P<0.05).The incidence rate of postoperative complications was comparable in the two groups(P>0.05).Conclusion The short-term advantage of Delta-shaped surgery in radical operation of laparoscopic distal gastric cancer is higher than that of Billroth Ⅰ.Delta-shaped surgery has relatively smaller surgical trauma,faster postoperative recovery,and higher clinical application value.

关 键 词：胃癌 腹腔镜远端胃癌根治手术 胃三角吻合术 毕Ⅰ式吻合术 

分 类 号：R656.61[医药卫生—外科学]