全腹腔镜远端胃双吻合器毕Ⅰ式吻合技术初步安全可行性评估  

Initial safety and feasibility evaluation of BillrothⅠreconstruction by double staplers after totally laparoscopic distal gastrectomy

作　　者：陈曦[1] 冯盈[1] 胡懿淋 李鹏[1] 薛万江[1] 毛勤生[1] CHEN Xi;FENG Ying;HU Yilin;LI Peng;XUE Wanjiang;MAO Qinsheng(Department of Gastrointestinal Surgery,Affiliated Hospital of Nantong University,Medical School of Nantong University,Nantong,Jiangsu 22600l,China)

机构地区：[1]南通大学附属医院胃肠外科一病区、南通大学医学院,江苏南通226001

出　　处：《中华肿瘤防治杂志》2023年第22期1357-1361,1380,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(82102825,82102720);江苏省自然科学基金(BK20221272)。

摘　　要：目的 探讨全腹腔镜远端胃癌根治术中应用双吻合器行胃十二指肠毕Ⅰ式吻合技术的安全性和可行性。方法 回顾性分析2014-01-01-2020-12-31南通大学附属医院胃肠外科接受全腹腔镜远端胃双吻合器毕Ⅰ式手术(全腔镜双吻合器组)的105例胃癌患者临床资料,并纳入同时期、同一手术团队实施腹腔镜辅助胃毕Ⅰ式手术(腹腔镜辅助组)的66例胃癌患者资料作为对照,观察比较2组术中和术后临床资料及术后并发症的情况。对2组间术中和术后临床资料如吻合重建时间、标本近端边缘、术中出血量、首次下床活动时间、肛门排气时间、进流质时间、术后住院时间和切口长度分别行t检验;2组术后并发症行χ^(2)检验。结果 全腔镜双吻合器组消化道重建时间为(21.60±4.15) min,少于腹腔镜辅助组的(24.84±3.56) min,t=2.963,P=0.005。全腔镜双吻合器组切口长度[(3.39±0.68) cm]短于腹腔镜辅助组[(6.15±1.27) cm],t=8.553,P<0.001。全腔镜双吻合器组和腹腔镜辅助组的距上切缘距离[(5.63±1.53)vs(5.01±1.21) cm]、术中出血量[(53.23±13.53)vs(51.71±9.14) mL]、术后首次下床活动时间[(1.50±0.51)vs(1.87±0.69) d]、术后自主肛门排气时间[(3.02±0.83)vs(3.66±1.31) d]、术后进流食时间[(3.80±0.99)vs(4.36±1.03) d]和术后住院天数[(7.20±1.62)vs(7.90±1.06) d]差异均无统计学意义,均P>0.05。全腔镜双吻合器组2例出现术后并发症(吻合口出血1例,吻合口狭窄1例),腹腔镜辅助组3例出现术后并发症(吻合口狭窄、切口脂肪液化和切口疼痛各1例),差异无统计学意义,P>0.05。结论 全腹腔镜远端胃双吻合器毕Ⅰ式吻合是一种安全可行的手术吻合方式。Objective To explore the safety and feasibility of Billroth I reconstruction by double staplers after totally laparoscopic distal gastrectomy.Methods We reviewed the clinical data of 105patients with gastric cancer who underwent BillrothⅠreconstruction by double staplers after totally laparoscopic distal gastrectomy(the double staplers group)in the Affiliated Hospital of Nantong University from January 2014to December 2020.Meanwhile,66patients with gastric cancer who were performed laparoscopy-assisted BillrothⅠreconstruction during the same period by the same surgical team were divided a control(the laparoscopy-assisted group).Intraoperative and postoperative outcomes,postoperative complications were observed.T-test analysis was used to compare intraoperative and postoperative outcomes between the two groups,such as the mean time of reconstruction,proximal resection margin,intraoperative blood loss,out-of-bed mobilization,first flatus after the operation,first liquid after the operation,postoperative hospital stay,the length of the incision.Chi-square analysis was performed on postoperative complications between the two groups.Results The mean time of reconstruction in the double staplers group was(21.60±4.15)min,which was significantly less than that in the laparoscopy-assisted group[(24.84±3.56)min],t=2.963,P=0.005.The length of the incision in the double staplers group was(3.39±0.68)cm,which was significantly shorter than that in the laparoscopy-assisted group[(6.15±1.27)cm](t=8.553,P<0.001).In the double stapler group and the laparoscopy-assisted group,there was no significant difference for the following factors(P>0.05),including proximal resection margin[(5.63±1.53)cmvs(5.01±1.21)cm],intraoperative blood loss[(53.23±13.53)ml vs(51.71±9.14)ml],out-of-bed mobilization[(1.50±0.51)days vs(1.87±0.69)days],first flatus after the operation[(3.02±0.83)days vs(3.66±1.31)days],first liquid after the operation[(3.80±0.99)days vs(4.36±1.03)days],postoperative hospital stay[(7.20±1.62)days vs(7.90±1

关 键 词：全腹腔镜远端胃切除术 毕Ⅰ式吻合 双吻合器技术 胃癌 可行性 

分 类 号：R735.2[医药卫生—肿瘤]