三角吻合技术在全腹腔镜下胃远端癌根治术中的应用

目的 探讨三角吻合技术在全腹腔镜下胃远端癌根治术中的可行性和临床疗效.方法 回顾性分析2012年11-12月间福建医科大学附属协和医院实施的18例全腹腔镜胃远端癌根治术并残胃十二指肠吻合(三角吻合)病例的临床资料.三角吻合是完全在腹腔镜下应用直线切割闭合器完成残胃和十二指肠后壁的功能性端端吻合,再利用直线切割闭合器闭合共同开口后,吻合口内部的缝钉线呈现为三角形.结果 18例患者均成功施行全腹腔镜下胃远端癌淋巴结清扫(D1+或D2)及三角吻合.手术时间(156.3±38.5) min,三角吻合耗时(24.6±11.2) min.肿瘤距上切缘(5.8±2.4) cm,距下切缘(4.1±2.7) cm,上、下切缘病理结果均未见癌残留.术中出血量(70.7±43.8) ml,淋巴结清扫数目(32.4±12.0)枚/例.术后首次下床活动时间(1.8±0.9)d,肛门排气时间(3.1±1.2)d,进食流质时间(3.6±1.7)d,术后住院时间(9.6±2.5)d.术后1例患者出现乳糜瘘伴腹腔感染;全组均未出现吻合口出血、吻合口狭窄或吻合口瘘等吻合口相关并发症.结论 三角吻合技术应用于全腹腔镜下胃远端癌根治术是安全可行的,近期疗效满意.

Application of delta-shaped anastomosis in totally laparoscopic distal gastrectomy

Objective To explore the technical feasibility, safety, and clinical efficacy of delta- shaped anastomosis in totally laparoscopic distal gastrectomy （TLDG）. Methods Clinical data of 18 patients with gastric cancer who received TLDG with delta-shaped anastomosis from November 2012 to December 2012 were retrospectively analyzed. The delta-shaped anastomosis is a new method of intraabdominal Billroth I anastomosis using only linear stapler. The posterior wall of the stomach and that of the duodenum were put together using linear stapler, and the common stab incision was also closed with linear stapler. The anastomosis was finished with a delta-shaped. Results TLDG with deltashaped anastomosis was successfully carried out in all the patients. The mean operation time and mean time for anastomosis were （156.3±38.5） minutes and （24.6±11.2） minutes. The lengths of upper and lower segment of resection form gastric cancer were （5.8±2.4） cm and （4.1±2.7） cm. Blood loss was （70.7±43.8） ml and number of dissected lymph nodes was 32.4±12.0 per patient. The average time to ground activities, time to flatus, time to fluid diet and length of hospital stay were （1.8±0.9） days, （3.1±1.2） days, （3.6±1.7） days, and （9.6±2.5） days, respectively. Only one patient developed chylus leak with intraabdominal infection. There was no mobility related to the anastomosis in all the patients. Conclusion The delta-shaped anastomosis is a safe and feasible procedure for totally laparoscopic distal gastrectomy and provides satisfactory short-term efficacy.