三角吻合技术在腹腔镜远端胃癌根治术中的应用

目的比较三角吻合的全腹腔镜远端胃切除术（totally laparoscopic distal gastrectomy，TLDG）与传统腹腔镜辅助下远端胃切除术（laparoseopie—assisted distal gastrectomy，LADG）的临床疗效。方法比较2013年1—6月我科32例三角吻合TLDG与32例传统腹腔外吻合的LADG临床资料。结果64例手术均获成功。LADG组1例出现吻合口漏，1例出现吻合口狭窄，吻合口相关并发症发生率6．2％（2／32）。TLDG组均未出现吻合口漏、吻合口狭窄或吻合口出血等吻合口相关并发症。三角吻合的TLDG组三角吻合耗时（30．0±12．8）min。与LADG组相比，TLDG组手术时间（177．9±37．9）minvs．（186．7±39．1）min，t=-0．914，P=0．364]、清扫淋巴结总数（33．4±11．8）枚VS．（31．8±12．1）枚，t=0．536，P=0．594]、进流质食时间（3．5±1．8）d vs．（3．7±1．7）d，t=-0．457，P=0．649]均无明显差异，但住院时间（8．2±2．4）dVS．（12．7±2．6）d，t=-7．194，P=0．000]、肛门排气时间（2．0±1．2）dVS．（3．5±1．3）d，t=-4．796，P=0．000]明显缩短，术中出血量中位数40ml（15～96m1）vs．中位数98ml（50～158m1），Z=-2．388，P：0．017]明显减少，且术后患者VAS评分术后第1天：（3．04-1．2）分vs．（6．0±1．6）分，t=-8．485，P=0．000；术后第3天：（1．7±0．7）分vs．（4．2±0．8）分，t=-13．304，P=0．000]和需要的止痛剂剂量（1．6±0．8）支vs．（3．7±2．8）支，t=-4．079，P=0．000]明显减少。结论三角吻合技术应用于全腹腔镜下远端胃癌根治术是安全可行的，近期效果显著。

The Application of Delta-shaped Anastomosis in Total Laparoscopic Distal Gastrectomy

Objective To compare the clinical efficacy of delta-shaped anastomosis in total laparoscopic distal gastrectomy （TLDG） and conventional laparoscopic-assisted distal gastrectomy （LADG）. Methods We retrospectively analyzed 32 cases of gastric cancer undergoing delta-shaped anastomosis in TLDG from January 2013 to March 2013, and 32 cases of gastric cancer undergoing LADG from April 2013 to June 2013. Results All procedures were completed successfully. The complication rate related to anastomosis was 6. 2% （2/32） in LADG group. One patient developed anastomotic leakage and one patient developed anastomotic stenosis in LADG, while no complications related to anastomosis occurred in TLDG with delta-shaped anastomosis. These complications included anastomotic leakage, stenosis and bleeding. No significant difference was found in mean operation time （177.9±37.9）min vs. （186.7 ±39.1）min, t = -0. 914, P=0.364], number of dissected lymph nodes （33.4 ±11.8） vs. （31.8±12.1）, t=0.536, P=0.594] and time to fluid diet intake （3.5±1.8）d vs. （3.7±1.7）d, t= -0.457, P=0.649] between LADG group and TLDG group. However there were marked difference in hospital stay （8.2 ± 2.4）d vs. （12.7 ± 2.6）d, t= -7.194, P=0. O00] and time to flatus （2.0±1.2）d vs （3.5 ±1.3 ）d, t= -4.796, P=0.000] between TLDG group and LADGgroup. Meanwhile the median of blood loss 40 m1（15 -96 ml） vs. 98 ml（50- 158 ml）, Z = -2.388, P=0.017], postoperative pain score first postoperative day： （3.0 ± 1.2） points vs. （6.0 ± 1.6） points, t = -8.485, P =0.000, third postoperative day ： （ 1.7 ± 0.7） points vs. （4.2 ± 0.8） points, t = - 13. 304, P = 0. 000 ] and dosage of pain killers （ 1.6 ± 0.8 ） vs. （3.7 ± 2.8 ） , t = - 4. 079, P = 0. 000 ] were significantly less in TLDG group than LADG group. Conclution The delashaped anastomosis is a safe and feasible procedure for total laparoscopic distal gastrectomy and provides satisfactory short-term efficacy.