腹腔镜下人工缝合行胃十二指肠吻合术36例临床分析  

Laparoscopic gastroduodenostomy with manual suture for Billroth Ⅰ anastomosis: a report of 36 cases

作　　者：周育成[1] 夏涛 牟一平[1] 鲁超[1] 金巍巍[1] 吴小三 邵红亮 王元宇[1] Zhou Yucheng;Xia Tao;Mou Yiping;Lu Chao;Jin Weiwei;Wu Xiaosan;Shao Hongliang;Wang Yuanyu(Department of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People′s Hospital,People′s Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院杭州医学院附属人民医院胃肠胰外科,310014

出　　处：《中华外科杂志》2020年第5期383-387,共5页Chinese Journal of Surgery

摘　　要：目的探讨腹腔镜下人工缝合行胃十二指肠吻合术的可行性。方法回顾性分析2017年11月至2019年9月于浙江省人民医院胃肠胰外科接受胃癌根治术+胃十二指肠吻合的36例胃癌患者的临床资料。男性22例,女性14例,年龄(64.3±9.3)岁(范围:43~80岁),于完全腹腔镜下行胃癌根治术,并采用腹腔镜人工缝合法进行胃十二指肠吻合。记录患者的手术时间、胃十二指肠吻合时间、术后肛门排气时间、拔除胃管时间等围手术期资料。结果全部患者成功实施完全腹腔镜远端胃癌根治性切除+人工缝合法胃十二指肠吻合,手术时间(226.7±40.4)min(范围:180~320 min),其中胃十二指肠吻合时间(24.8±7.1)min(范围:15~48 min),术后肛门排气时间(3.8±0.9)d(范围:2~6 d),拔除胃管时间(5.7±2.0)d(范围:3~13 d),术后住院时间(10.3±3.1)d(范围:7~19 d)。围手术期无死亡病例。术后病理学检查示高分化腺癌3例,中分化腺癌5例,低分化腺癌22例,印戒细胞癌6例;T1期27例,T2期9例;淋巴结清扫数目(36.4±8.9)枚(范围:23~60枚),淋巴结转移阳性7例,阴性29例。TNM分期:ⅠA期24例,ⅠB期8例,Ⅱ期4例。术后复查上消化道造影,吻合口均通畅,无吻合口狭窄等并发症。结论腹腔镜人工缝合法行胃十二指肠吻合术安全可行,具有较好的近期疗效。Objective To examine the clinical efficiency of laparoscopic gastroduodenostomy with BillrothⅠanastomosis with manual suture.Methods The clinic data of 36 patients with gastric cancer who underwent laparoscopic gastroduodenostomy with BillrothⅠanastomosis from November 2017 to September 2019 in Department of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People′s Hospital were analyzed retrospectively.There were 22 males and 14 females,aged(64.3±9.3)years(range:43 to 80 years),underwent complete laparoscopic gastroduodenostomy.The laparoscopic manual suture was used for BillrothⅠanastomosis.Results All the laparoscopic radical gastrectomy and manual suturing gastroduodenostomy were successfully performed.The operation time was(226.7±40.4)minutes(range:180 to 320 minutes),including(24.8±7.1)minutes(range:15 to 48 minutes)for gastroduodenostomy.There was(3.8±0.9)days(range:2 to 6 days)for anal exhaust,(5.7±2.0)days(range:3 to 13 days)for extubation of gastric tube,and(10.3±3.1)days(range:7 to 19 days)for hospitalization.There was no death in perioperative period.Postoperative pathological report showed 3 cases of highly differentiated adenocarcinoma,5 cases of moderately differentiated adenocarcinoma,22 cases of poorly differentiated adenocarcinoma and 6 cases of signet ring cell carcinoma,including 27 cases in T1 stage and 9 cases in T2 stage.The number of lymph nodes harvested was 36.4±8.9(range:23 to 60).Lymph node metastasis was positive in 7 cases and negative in 29 cases.TNM stage included 24 cases inⅠA stage,8 cases inⅠB stage and 4 cases inⅡstage.After the operation,the upper digestive tract radiography showed that the anastomosis opening was unobstructed without complications such as anastomotic stenosis.Conclusion Laparoscopic gastroduodenostomy with BillrothⅠanastomosis with manual suture is safe and feasible,has a good short-term effect.

关 键 词：胃肿瘤 腹腔镜检查 胃肠吻合术 缝合技术 

分 类 号：R735[医药卫生—肿瘤]