全腹腔镜下胃癌根治术中应用免打结可吸收倒刺线关闭共同开口的可行性研究

目的:探讨完全腹腔镜胃癌根治术中应用免打结可吸收倒刺线(KBAS)连续缝合关闭共同开口的可行性及安全性。方法:回顾分析2016年6月至2019年12月施行完全腹腔镜胃癌根治术并应用KBAS连续缝合关闭共同开口的557例患者的围手术期临床资料及术后并发症发生率。结果:394例行全腔镜下远端胃癌根治、毕Ⅱ式+Braun吻合术,163例行完全腹腔镜下全胃根治性切除术及食管空肠顺蠕动侧侧吻合(Overlap吻合),均以KBAS连续缝合关闭共同开口。远端胃癌根治组与全胃切除组手术时间平均(147.2±16.1)min与(201.5±27.4)min,共同开口缝合时间为(9.1±2.4)min与(13.2±4.4)min。两组均无术后吻合口出血;其中1例Overlap患者术后出现吻合口漏,2例远端胃癌患者术后出现十二指肠残端瘘,1例远端胃癌患者出现疑似吻合口漏的腹腔严重感染,因患者家属放弃进一步检查与治疗自动出院,无法明确。全胃Overlap吻合组术后4例出现有症状的轻微吻合口梗阻,余者均未发生相关并发症。结论:完全腹腔镜胃癌根治术中应用KBAS连续缝合关闭共同开口术后近期并发症发生率较低,是简单、可行、安全的。

Feasibility research on the application of knotless barbed absorbable sutures for close of common opening in total laparoscopic radical gastrectomy

Objective:To investigate the feasibility and safety of using knotless barbed absorbable sutures(KBAS)in the close of the common opening after totally laparoscopic radical gastrectomy.Methods:The perioperative clinical data and postoperative complications of 557 patients who underwent continuous suture of common opening with KBAS after totally laparoscopic radical gastrectomy from Jun.2016 to Dec.2019 were retrospectively analyzed.Results:Among them,394 patients underwent totally laparoscopic distal gastrectomy with Billroth-Ⅱplus Braun anastomosis,and 163 patients underwent totally laparoscopic total gastrectomy with esophageal-jejunal lateral anastomosis(Overlap method).All patients underwent KBAS continuous suture to close the common opening.The average operation time of the distal gastrectomy group and total gastrectomy group were(147.2±16.1)min and(201.5±27.4)min respectively,and the average suture time of the common opening were(9.1±2.4)min and(13.2±4.4)min,respectively.There was no postoperative anastomotic bleeding in the two groups.One patient with total gastrectomy suffered from anastomotic leakage after surgery,and two patients with distal gastrectomy developed duodenal stump fistula after surgery.One patient with distal gastrectomy developed severe abdominal infection,which was suspected to be caused by anastomotic leakage.However,the patient was automatically discharged from the hospital because the patient’s family gave up further examination and treatment.Four patients in the total gastrectomy group postoperatively appeared minor anastomotic obstruction symptoms,and other patients had no related complications.Conclusions:In total laparoscopic gastrectomy,continuous suture of the common opening with KBAS does not increase the incidence of short-term complications compared with conventional methods,the technique is simple,feasible and safe.