腹腔镜胃手术结合辅助切口十二指肠残端处理方法改进的临床研究

目的探讨腹腔镜胃手术结合辅助切口十二指肠残端处理方法改进的临床应用效果。方法回顾分析68例腹腔镜胃手术患者的临床资料,其中腹腔镜下十二指肠残端处理24例(A组),结合辅助切口十二指肠残端处理44例(B组)。结果 68例患者均顺利完成手术。A组较B组手术时间长、出血量多(P<0.05);两组切口长度、远/近切缘及淋巴结清扫数目比较均无统计学差异(P>0.05);两组患者术后恢复指标(肛门排气时间、进食流质时间、下床活动时间及住院时间)比较亦无统计学差异(P>0.05)。术后A组发生切口感染、吻合口出血各1例,B组切口感染2例、吻合口出血1例,均经保守治疗痊愈。两组术后并发症发生率无统计学差异(8.33%VS 6.82%,P>0.05)。全组无手术死亡、吻合口漏及十二指肠残端漏。A组十二指肠残端闭合费用8 660.50元,高于B组材料费用120.00元(P<0.05)。结论腹腔镜胃手术结合辅助切口十二指肠残端处理在保留微创优势的同时更有利于缩短手术时间,减少出血,直视下更容易处理幽门上下复杂的病理情况,降低手术风险及难度,减少并发症,并能大大降低手术费用。

Management of Duodenal Stump under Laparoscope Combined Assisted Incision in Laparoscopic Gastric Operation

Objective To explore the clinical effect of management of duodenal stump under laparoscope combined assisted incision in laparoscopic-assisted gastric operation.Methods The clinical data of 68 cases treated by laparoscopic-assisted gastric operation were analyzed retrospectively.Among them,24 cases(group A) were performed duodenal stump management by laparoscope,44 cases(group B) were performed duodenal stump management by laparoscope combined assisted incision.Results Laparoscopic-assisted gastric operation was performed successfully in all 68 patients.Both operative duration and intraoperative blood loss of group A was higher than those of group B(P<0.05).Between two groups,there was no difference in length of incision,distance from distal or near excised margin to the tumor,the number of lymph nodes excised and postoperative recovery index,including gastrointestinal recovery time,time for resuming to diets,time of out-of-bed activity and length of hospital stay(P>0.05).Postoperative infection and anastomotic stoma bleeding was found in 1 patient respectively in group A,and in 2 and 1 case respectively in group B,and no difference in the rate of postoperative complication between two groups(P>0.05).No operative death,stomal leak and duodenal stump leakage occurred in all the 68 cases.The cost of duodenal stump management was 8 660.50 in group A,and was obviously higher than 120 in group B(P>0.05).Conclusion The management of duodenal stump by laparoscope combined assisted incision is safe and effective for laparoscopic-assisted gastric operation with advantages as short operation duration,less blood loss,easy exposure for adjacent pylorus lesion,low difficulty degree and operative risk,less complication and decreasing surgery cost,but the long-term outcome needs to be observed.