胃癌全胃切除手法和吻合器缝合的比较

目的比较胃癌全胃切除术手法和机械重建消化道的手术时间、输血量、并发症及死亡率。方法1993年1月至2000年12月我科共施行胃癌全胃切除术140例,按手法吻合和吻合器吻合重建消化道分为两组,手法吻合组53例,吻合器吻合组87例。两组的肿瘤部位、分期无明显差别。结果手法组输血量为(443±432)ml,器械组为(430±435)ml(P＞0.05)。手法组手术时间为(254±98)min,器械组为(211±87)min(P＜0.05)。肺部感染手法组6例,器械组8例。切口感染手法组1例,器械组2例。吻合口狭窄两组各1例,吻合口瘘和术后出血手法组分别为2例和1例,器械组无吻合口瘘和术后出血。手法组死亡1例,器械组无死亡。结论吻合器吻合重建消化道能节约手术时间,减少总手术并发症。

Comparative analysis of manual and stapler anastomoses after total gastrectomy for gastric cancer

Objective To compare the operating duration, the volume of blood transfusion, morbidity and mortality in gastrointestinal reconstruction after total gastrectomy for gastric cancer between manual and stapler anastomoses. Methods From January 1993 to December 2000, 140 patients underwent total gastrectomy for gastric cancer. The patients were divided into two groups according to the method of gastrointestinal reconstruction. There were 53 patients in group A in which anastomosis was performed with manual procedure and 87 patients in group B with stapler. There was no significant difference in the location and clinical stage of the carcinoma between the two groups. Results The mean volume of blood transfusion was (443±432) ml in group A and (430±435) ml in group B(P＞0.05) . The mean operating duration was (254±98)minutes in group A and (211±87 )minutes in group B respectively(P＜0.05) . Pulmonary infection and incision infection occurred in 6 and 1 patients respectively in group A, whereas 8 and 2 patients respectively in group B. Anastomotic stenosis occurred in 1 patient in both groups. Two patients were complicated with leakage, 1 with postoperative bleeding and 1 died in group A, but no such complications were found and none died in group B. Conclusion For gastrointestinal reconstruction, the use of stapler can shorten the operating duration and reduce overall morbidity.