Delta吻合在全腹腔镜远端胃癌根治术消化道重建中的安全性和远期疗效的临床分析  

Clinical analysis of safety and long‐term effect of Delta‐shaped anastomosis in gastrointestinal reconstruction after total laparoscopic radical gastrectomy for distal gastric cancer

作　　者：程伏林[1] 姜毅楠 蔡小鹏[1] 彭春伟[1] 杨肖军[1] 黄超群[1] 王舒艺[1] 石东东 冯茂辉[1] 熊斌[1] 李炫飞 CHENG Fulin;JIANG Yinan;CAI Xiaopeng;PENG Chunwei;YANG Xiaojun;HUANG Chaoqun;WANG Shuyi;SHI Dongdong;FENG Maohui;XIONG Bin;LI Xuanfei(Dept.of Gastrointestinal Surgery,Zhongnan Hospital of Wuhan University,Key Laboratory of Tumor Biology Behavior of Hubei Province&Clinical Cancer Study Center of Hubei Province,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院胃肠外科/湖北省肿瘤生物学行为重点实验室/湖北省肿瘤医学临床研究中心,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2022年第6期935-939,951,共6页Medical Journal of Wuhan University

基　　金：国家自然科学基金资助项目(编号:81902018);湖北省自然科学基金资助项目(编号:2012FFB04413);武汉市腹膜癌临床医学研究中心资助项目(编号:2015060911020462)。

摘　　要：目的:探讨Delta吻合在全腹腔镜远端胃癌根治手术中手术技巧、安全性及远期疗效。方法:回顾性分析我院41例在2015年7月—2021年8月实施全腹腔镜远端胃癌根治术Delta吻合的关注指标、围手术期情况、并发症和远期生存疗效。对手术和重建时间、术中出血量、手术切口长度、疼痛感、下床、通便和进食时间、术后并发症、住院日、淋巴结清扫数目、营养状况等进行分析。术后均全程随访,随访截止日期为2021年8月31日。结果:41例患者均顺利进行手术,手术时间为165(147,184)min,消化道重建时间为51(43,77)min,术中出血量为85(60,110)mL,腹壁切口长度4~6 cm,38例患者在术后1~2 d拔除胃管,均未发现明显的吻合口出血。所有患者均无明显的术后疼痛,在术后1~2 d下床运动。37例患者在手术3~5 d之内恢复肠道通气。35例患者术后4 d内进流质饮食。41例均未出现伤口感染和腹腔感染,6例患者出现肺部感染,5例患者出现淋巴瘘。全部患者均未出现吻合口漏、吻合口狭窄和吻合口出血。分别有2例患者出现反流性胃食管炎和胃功能不全。术后住院时间平均(6.0±1.7)d。全组患者未出现手术相关死亡。所有病人均行标准的D2根治手术,清扫淋巴结数量为36(28,48)枚,阳性淋巴结数量为2(0,3)枚。术后TNM分期Ⅰ、Ⅱ、Ⅲ期分别有16例、23例和2例。全部患者均获得全程跟踪随访,随访率100%,术后1月内复查患者总蛋白和血清蛋白以及前白蛋白,均恢复到正常值水平。在随访期内未发现肿瘤复发或者转移。结论:Delta吻合在腹腔镜胃癌根治性术消化道重建中是安全可行的,可提高患者术后生存质量,同时可获得良好的远期疗效。Objective:To investigate the surgical technique,safety and long⁃term effect of Delta⁃shaped anastomosis in total laparoscopic radical gastrectomy for distal gastric cancer.Methods:The con⁃cerned indexes,perioperative conditions,complications and long⁃term survival effects of Delta⁃shaped anastomosis in 41 cases of total laparoscopic radical gastrectomy for distal gastric cancer in our hospi⁃tal from July 2015 to August 2021 were analyzed retrospectively.The operation and reconstruction time,intraoperative bleeding,incision length,pain,offbed time,first defecation time and first oral in⁃take time,postoperative complications,hospital stay,number of lymph node dissections,and nutri⁃tional status were analyzed.All patients were followed up in the whole process and the deadline for follow⁃up was August 31,2021.Results:All 41 patients underwent the operation successfully.The operation time was 165(147,184)min,the digestive tract reconstruction time was 51(43,77)min,the amount of intraoperative bleeding was 85(60,110)mL,and the length of abdominal wall incision was 4⁃6 cm.Gastric tubes were pulled out in 38 patients within 2 days after operation.No obvious anastomotic bleeding was found.All patients had no obvious postoperative pain and could exercise offbed within 1 or 2 d after operation.37 patients recovered passage of flatus within 3⁃5 days and 35 patients received liquid diet within 4 days after operation.No wound infection and abdominal infection was found,but 6 cases developed lung infection and 5 cases had lymphatic fistula.No anastomotic leakage,anastomotic stenosis,and anastomotic bleeding was found.Reflux gastroesophageal inflam⁃mation and gastric insufficiency occurred in 2 patients respectively.The average postoperative hospi⁃tal stay was(6.0±1.7)d.There was no operation related death in the whole group.All patients un⁃derwent standard D2 radical operation.The median number of lymph nodes cleaned in each case ranged was 36(28,48)and the number of positive lymph nodes was 2(0,3).

关 键 词：Delta吻合 全腹腔镜胃癌根治术 消化道重建 

分 类 号：R735.3[医药卫生—肿瘤]