管型吻合器与线型吻合器用于腹腔镜远端胃癌根治术毕Ⅱ式吻合的疗效比较  

Dissection of the infra-pyloric lymph nodes in laparoscopic radical resection of right colon cancer

作　　者：汪兵[1] 吴泽晖 刘刚 赵海远 张义胜[1] 赵军[1] WANG Bing(Department of Gastrointestinal Surgery,The Yijishan Hospital of Wannan Medical College,Wuhu,Anhui 241000,China)

机构地区：[1]皖南医学院弋矶山医院胃肠外科,安徽芜湖241000

出　　处：《齐齐哈尔医学院学报》2020年第8期962-964,共3页Journal of Qiqihar Medical University

基　　金：2018年安徽省自然科学基金(1808085MH271)。

摘　　要：目的比较管型吻合器和线型吻合器在腹腔镜远端胃癌切除术的毕Ⅱ吻合的安全行和近期临床效果。方法回顾性分析2017年1月—2019年5月在本院胃肠外科行腹腔镜远端胃癌根治术的胃癌患者的临床资料,共92例,依据毕Ⅱ式吻合时选择的吻合器不同,分为线型吻合器组(50例)和管型吻合器组(42例)。统计分析两组术后手术时间、吻合时间、清扫淋巴结数目、术后住院天数、住院费用以及并发症的情况。结果线型吻合器组的术中出血量为(44.8±38.7)ml,少于管型吻合器组的(68.1±51.2)ml,差异有统计学意义(P<0.05)。线型吻合器组的术后第一次排气时间为(3.1±0.7)天,早于管型吻合器组的(3.8±1.1)天,差异有统计学意义(P<0.05)。两组在手术时间、吻合时间、清扫淋巴结数目、术后住院天数以及住院费用上差异无统计学意义(P>0.05)。线型吻合器组总并发症数为4例(8%),少于管型吻合器组总并发症数10例(23.8%),差异有统计学意义(P<0.05),在吻合口漏、十二指肠残端漏、胃瘫以及切口感染的每一项并发症发生率上差异无统计学意义(P>0.05)。结论腹腔镜远端胃癌根治术后毕Ⅱ式吻合时使用线型吻合器是安全可靠的。Objective To explore the clinical curative effect of dissection of the infra-pyloric lymph nodes in laparoscopic radical resection of right colon cancer.Methods From July 2017 to December 2018,the data of 70 cases of patients those received laparoscopic assisted right hemicolectomy in the Yijishan Hospital of Wannan Medical College were analyzed.There are divided into two groups according to whether dissected the infra-pyloric lymph nodes:dissection group(n=30)and un-dissection group(n=40).Parameters including operation time,intra-operative blood loss,anastomotic leakage,stoma bleeding,infra-pyloric lymph nodes,infection of incision wound and intestinal obstruction of the two groups were compared.Results All the procedures of the laparoscopic operations of the 70 patients were successfully performed.The clinical data of the two groups were comparable(P>0.05).The operative time of the dissection group(122.3±13.2)was longer than the un-dissection group(114.1±11.5)min,there was statistically significant difference between the two groups(P<0.05).There were no significant different in intra-operative blood loss and the incidence of intra-operative and postoperative complications in the two groups(P>0.05).Preserving the right gastroepiploic vessels during the dissection of infra-pyloric lymph nodes did not increase intra-operative risk.The tumor located in the hepatic curvature of the colon was likely to occurs infra-pyloric lymph node metastasis,and lymph node metastasis were more likely to occur in the patients of stageⅡright colon cancer according to TNM staging system.Conclusions The infra-pyloric lymph nodes should be dissected during laparoscopic radical resection of the right colon cancer,especially for patients with colonic hepatic flexure carcinoma.It is also recommended to preserve the right gastroepiploic vessels to improve the postoperative quality of life and survival.

关 键 词：腹腔镜 线型吻合器 管型吻合器 胃癌 

分 类 号：R735.2[医药卫生—肿瘤]