胰十二指肠切除术后胰胃吻合术与胰肠吻合术的营养状况比较

目的比较胰十二指肠切除术后胰胃吻合术与胰肠吻合术患者的远期营养状况。方法回顾性分析2006年4月至2010年12月间在中山大学附属第一医院胃肠胰腺外科接受胰十二指肠切除术的37例患者的临床资料,其中胰胃吻合者19例,胰空肠吻合者18例。比较两组患者的体质量指数（BMI）以及白蛋白、前白蛋白和转铁蛋白等营养参数。结果胰胃吻合组和胰空肠吻合组的手术时间、术中失血量、术后胰瘘发生率、围手术期死亡率及术后住院时间的差异均无统计学意义（均P〉0．05）。术后1个月,胰胃吻合组和胰肠吻合组的BMI分别为（17．1±7．0）和（19．0±4．8）kg／m2。白蛋白分别为（30．1±0．5）和（32．1±1．3）g／L,转铁蛋白分别为（1．89±0．57）和（2．01±0．61）g／L,前白蛋白分别为（0．18±0．05）和（0．18±0．09）g／L。较术前均略有下降,但两组间差异并无统计学意义（均P〉0．05）。术后6个月,两组的上述营养参数均恢复到术前或高于术前水平,但两组间差异仍无统计学意义（均P〉0．05）。结论胰十二指肠切除术后胰胃吻合和胰空肠吻合对患者术后营养状况的影响无明显差别。     

腹腔镜胃后、结肠后路胃空肠Roux—en—Y吻合术治疗单纯性肥胖症22例

目的探讨腹腔镜胃旁路手术方式中,胃后路胃空肠吻合手术方式的可行性和临床价值。方法2010年12月～2012年3月,对体重指数（BMI）≥35．0的单纯性肥胖症病例行结肠后腹腔镜胃空肠Roux—en—Y吻合术,随意分组,胃后路径22例,胃前路径38例。对比2组手术时间、出血量、术后住院时间、术后近期并发症发生率,术后6个月体重、BMI、多余体重减除率（EWL％）的差异。结果胃后路组手术时间较胃前路组长[（157．2±9．2）minVS．（144．9±12．1）min,t=-4．127,P=0．000];2组术中出血量,术后住院时间,术后6个月体重、BMI、EWL％差异均无显著性。胃前路组8例（21％）术后出现呕吐等上消化道不全梗阻症状,均在1周内缓解;胃后路组未出现类似并发症（P=0．022）。结论胃后路腹腔镜胃旁路手术是一种可行的术式,相比胃前路术式更符合生理,术后胃肠道近期并发症较少,胃肠道功能恢复较快。     

全胃切除后非离断式Roux—en—Y空肠储袋消化道重建的临床研究

目的探讨全胃切除术后非离断式Roux-en—Y空肠储袋消化道重建方式的临床效果。方法对168例胃癌患者行全胃切除手术后分别行非离断式Roux-en—Y空肠储袋吻合术（A组，69例）、P型空肠食管Roux-en-Y吻合术（B组，50例）和Orr式空肠食管Roux—en-Y吻合术（C组，49例）进行消化道重建。观察各组患者消化道重建的时间和术后并发症发生率；并对其中无瘤生存超过1年的121例患者的生活质量[术后6和12个月时的体重、进食量、预后营养指数（PNI）和Visick分级指数]进行分析对比。结果A、B、C组消化道重建时间分别为（30±7）min、（57±6）min和（48±6）min；A组时间最短，与B、C组比较差异有统计学意义（P〈0．05）。3组患者术后均顺利恢复，未发生吻合口瘘或十二指肠残端瘘等术后并发症。A、B、C组碱性反流性食管炎发生率分别为4．3％（2／46）、7．7％（3／39）和5．6％（2／36），差异无统计学意义（P〉0．05）；Roux潴留综合征发生率分别为2．2％（2／46）、17．9％（7／39）和19．4％（7／36），A组明显低于B、C组（P〈0．01）。术后6个月和12个月，A组体重和进食量的恢复均优于B、C组（P〈0．05）。与术前相比，术后6个月3组PNI均下降（P〈0．05）；12个月时，A组PNI与术前比较差异已无统计学意义（P〉0．05），而B、C组的差异仍有统计学意义（P〈0．05）。A组术后6个月和12个月时的Visick分级指数Ⅰ～Ⅱ级均优于B、C组（P〈0．05）。结论非离断式Roux-en—Y空肠储袋术是全胃切除术后理想的消化道重建术式。     

近端胃癌患者根治性切除术后三种消化道重建方式的对比研究

目的比较胃底贲门癌患者根治性胃切除术后不同消化道重建术式的反流性食管炎发生情况及生活质量。方法前瞻性人组2010年2月至2011年8月间河南省肿瘤医院收治的、拟行根治性胃切除的123例胃底贲门癌患者,按照随机数字表法分为3组,每组41例,在根治性胃切除术后分别行空肠间置吻合术、食管残胃后壁吻合术及食管空肠Roux-en-Y吻合术。分别于术前和术后1月行胃排空试验和食管下段pH值测定以评估患者食管反流情况．追踪肝肾功能及血常规变化情况：于术前和术后12月评估患者肝肾功能及生活质量。结果3组患者手术前、后血常规和肝肾功能指标的变化均无统计学意义（均P〉0．05）。术后空肠间置吻合组、食管残胃后壁吻合组和食管空肠Roux—en—Y吻合组分别有1例（2．4％）、10例（24．4％）和7例（17．1％）患者出现反流性食管炎症状,差异具有统计学意义（P=0．017）;分别有1例（2．4％）、7例（17．1％）和8例（19．5％）患者于上消化道钡餐造影检查时发现钡剂反流入食管,差异有统计学意义（P=0．046）;食管下段pH值分别为6．9±0．2、6.8±0．1和6．9±0．1,差异无统计学意义（P=0．196）。术后1年,3组患者在整体健康状况、躯体功能、情绪功能、疲劳、恶心呕吐、疼痛症状、便秘及腹泻方面的生活质量评分明显优于术前（均P〈0．05）;空肠间置吻合组患者在整体健康状况、情绪功能、恶心呕吐、便秘及腹泻方面的生活质量评分显著优于其他两组（均P〈0．05）。结论近端胃癌患者根治性胃切除术后采用空肠间置吻合术、食管残胃后壁吻合术及食管空肠Roux—en—Y吻合术均能够满足消化道重建的需要,能够有效地改善患者的生活质量;其中空肠间置吻合重建术在减少反流性食管炎的发生和提高患者生活质量方面的效果更为显著,是比较理想的近端胃癌根治术后消化道重建术式。     

早期食管胃结合部腺癌切除术后3S空肠间置与食管胃吻合两种消化道重建方式的对比研究

目的：探讨早期食管胃结合部腺癌根治术后消化道重建的理想方式。方法河南科技大学第一附属医院胃肠肿瘤外科前瞻性入组2003年1月至2011年12月接受根治性切除术的Ⅱ型和Ⅲ型早期食管胃结合部腺癌患者153例。按照随机数字表法分为3S吻合组（80例,采用3S空肠间置法吻合）和传统吻合组（73例,采用食管残胃后壁吻合）。观察比较两组患者近、远期并发症发生率、营养指标及术后生活质量。结果3S吻合组与传统吻合组手术时间[（163．2±12．3） min比（154．7±14．1） min]及围手术期并发症发生率[7．5％（6/80）比13．7％（10/73）]的差异均无统计学意义（均P＞0．05）。从术后6月开始,3S吻合组的血清总蛋白、白蛋白、血红蛋白及维生素B12等营养指标均明显高于传统吻合组（均P＜0．05）。术后18月,3S吻合组较传统吻合组反流性食管炎发生率明显降低[20．0％（16/80）比46．6％（34/73）, P＜0．01],胃排空时间明显延长[（160．8±8．1） min 比（61．1±10．8） min, P＜0．01]。术后QLQ-C30量表调查结果显示,3S吻合组术后生活质量明显高于传统吻合组（P＜0．05）。结论Ⅱ型和Ⅲ型早期食管胃结合部腺癌近端胃切除后采用3S空肠间置法进行消化道重建,具有良好的抗反流效果,可改善患者的远期营养状况和生活质量。     

全胃切除术后三种消化道重建术式的比较研究

目的 探讨全胃切除术后合理的消化道重建方式。方法对189例胃癌患者全胃切除术后分别采用了Orr式Roux-en-Y空肠食管吻合术、P形空肠袢空肠食管Roux-en-Y吻合术和Moynihan式吻合术进行消化道重建，对其手术时间、手术并发症、术后1、3年饮食状况和消化道症状及营养指标进行对比观察。结果3种术式的患者手术死亡率、术后1年和3年的饮食状况、腹泻和倾倒综合征的发生率比较，均P〉0．05；差异无统计学意义。术后1、3、5年的累计生存率比较，P〉0．05，差异也元统计学意义。Orr式空肠食管Roux-en-Y吻合术和P形空肠袢空肠食管Roux-en-Y吻合术后均能有效地防止反流性食管炎，明显优于Moynihan式吻合术（P〈0．01）。Orr式空肠食管Roux-en-Y吻合术较P形空肠袢空肠食管Roux-en-Y吻合术操作简单、手术时间短、手术并发症也较少。结论Orr式空肠食管Roux-en-Y吻合术是胃癌全胃切除后消化道重建较为合适的术式。     

连续性空肠间置在胃次全切除术消化道重建中的应用研究

目的 探讨胃次全切除术时采用连续性空肠间置完成消化道重建的临床效果。方法 远端胃癌患者34例，随机分成两组，A组16例，B组18例。胃次全切除后，A组行残胃与空肠、十二指肠与空肠的端侧吻合，再行空肠侧侧吻合，将胃空肠吻合的输入袢空肠和十二指肠空肠吻合口的输出袢空肠分别结扎阻断，形成完整的连续性间置空肠代胃。B组行Billroth Ⅱ式消化道重建。比较两组患者术后并发症发生率和死亡率；术后1年比较两组患者的Visiek分级指数、血浆白蛋白水平、每餐进食量和体重，并用胃镜检查残胃和吻合口情况。结果 两组患者术后均未出现并发症。术后1年观察，Visiek分级指数两组比较，u=2．1，P〈0．05；差异有统计学意义。A组所有患者平均每日进食量均在术前水平的85％以上，B组只有14人达到该水平。两组手术前后体重减少值比较，t=-2．181，P〈0．05；差异有统计学意义。两组手术前后血浆白蛋白变化值对比，差异有统计学意义（t=2．125，P〈0．05）；A组在1年后显著增加，与术前相比（t=-2．175，P〈0．05）差异有统计学意义。手术后1年胃镜复查，A组残胃未发现胆汁反流，吻合口通畅，吻合口黏膜和间置空肠无充血、水肿，而B组发现残胃内胆汁潴留11例（61．1％），吻合口炎症13例（72．2％），吻合口溃疡2例（11．1％）。结论 连续性空肠间置能够恢复消化道生理通道并避免反流性胃炎的发生。     

腹腔镜下远端胃癌根治术Billroth Ⅱ式吻合不同吻合方式的疗效影响

目的探讨使用不同的吻合器械行胃空肠吻合在腹腔镜下胃远端癌根治术中的临床疗效。方法回顾性分析2006年6月至2011年9月间实施的205例腹腔镜下胃远端癌根治术并Billrot Ⅱ赋胃空肠吻合病例的临床资料。胃空肠吻合分别采用切割闭合器（102例）和圆形吻合器（103例）完成。应用Spssl7．0统计软件进行分析,两组术中和术后数据以x^-±s表示,采用t检验;两组并发症发生率组间比较采用χ^2检验或Fisher确切概率法。结果205例患者均成功施行腹腔镜下胃远端癌淋巴结清扫及胃空肠吻合。切割闭合器组和圆形吻合器组术后并发症总发生率分别为10．8％（11／102）和12．6（13／103）（χ^2=0．683,P〉0．05）,两组在肠梗阻、腹腔内出血、吻合口梗阻、吻合口漏、吻合口出血、胃排空障碍、反流性食管炎、后期倾倒综合征并发症的发生率差异无统计学意义;两组患者总手术时间分别为（240．3±89．2）min和（245．5±82．1）min;术中出血量分别为（158．2±28．4）ml和（156．6±30．4）ml;术后下床时间分别为（1．8±1．6）d和（1．8±1．4）d;肛门恢复通气时间分别为（2．8±1．4）d和（2．9±1．3）d;进半流食时间分别为（3．6±0．8）d和（3．6±1．2）d;术后住院时间分别为（7．9±2．3）d和（8．0±2．1）d;住院费用分别为（35153．2±10163．0）元和（33103．0±10125．1）元,两组差异均无统计学意义（P〉0．05）。结论腹腔镜下胃远端癌根治术采用切割闭合器和圆形吻合器行胃空肠吻合手术,两种吻合方式具有相同的安全性和相似的疗效。     

腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病62例分析

目的探讨腹腔镜Roux—en-Y胃旁路术（LRYGB）在2型糖尿病治疗中的临床应用。方法回顾性分析2010年5月至2011年10月间在苏州大学附属第一医院接受LRYGB手术的62例2型糖尿病患者的临床和随访资料。结果62例患者中58例顺利完成LRYGB术．手术时间（144．5±59．0）min,术中出血量（57.8±135．5）ml。术后吻合口出血2例,胃瘫2例,吻合口瘘1例．营养不良1例,均经保守治疗缓解;另有1例吻合口狭窄患者。经球囊扩张后缓解。49例患者获得了术后6个月的随访,其中34例临床完全缓解（完全停药）,9例临床部分缓解（用药量较术前减少）,6例无效。患者术后体质量指数、空腹血糖、糖化血红蛋白均较术前有明显改善（均P〈0．05）。与术后仍需服用降糖药者相比,临床完全缓解的病例术前体质量指数更高、病程更短（均P〈0．05）。结论LRYGB用于治疗2型糖尿病安全、可行,短期效果良好．长期效果有待观察。     

腹腔镜全胃切除后两种食管空肠吻合方式疗效的前瞻性研究

目的探讨腹腔镜全胃切除手术中两种抵钉座置入方式行食管空肠吻合的临床疗效。方法前瞻性分析2011年5月至2012年10月南京大学医学院附属鼓楼医院收治的18例食管胃结合部腺癌和14例胃体癌患者的临床资料。32例患者行腹腔镜全胃切除术,常规行D：淋巴结清扫,切除全胃后抽取信封（术前按1：1每组各设16个信封,采用随机数字表法将信封混合,按手术时间顺序打开信封在术中决定患者分组）将患者分为经口抵钉座置入组（OrVil组,食管胃结合部腺癌7例、胃体癌9例）和反式抵钉座置入组（HDST组,食管胃结合部腺癌11例、胃体癌5例）。采用电话和门诊随访,了解患者进食情况和预后。随访时间截至2012年12月。计量资料两组间比较采用Student’St检验,计数资料采用Fisher确切概率法。结果32例患者均成功施行腹腔镜全胃切除术,无一例中转开腹。OrVil组和HDST组患者手术时间、切除全胃及淋巴结清扫时间、消化道重建时间分别为（3034-51）rain、（153±35）min、（57±15）min和（2834-49）min、（160±31）min、（48±12）min,两组比较,差异无统计学意义（t=1．19,0．59,1．78,P〉0．05）。OrVil组和HDST组患者完成吻合器抵钉座的放置时问分别为（18±6）min和（13±5）min,两组比较,差异有统计学意义（t=2．56,P〈0．05）。OrVil组和HDST组患者术中出血量、淋巴结清扫数目、腹壁切El长度、术后肛门排气时间、下床活动时间、进食时间、住院时间分别为（96±30）mL、（24±5）枚、（3．74-0．4）cm、（3．44-0．9）d、（3．9±0．7）d、（7．6-4-1．4）d、（10．44-1．6）d和（924-40）mL、（27-4-5）枚、（3．6±0．6）em、（3．34-1．0）d、（3．5±0．7）d、（8．3±3．0）d、（11．14-3．8）d,两组比较,差异无统计学意义（t=0．35,0．0l,2．50,0．37,1．51,0．82,0．67,P〉0．05）。OrVil组和HDST组食管胃结合部腺癌患者的食管近端切缘与肿瘤距离分别为（3．14-0．5）Cfll和（2．94-0．6）cm,两组无一例患者发现肿瘤残留。两组患者术后近期疗效良好,无吻合口狭窄、胆汁反流等发生。OrVil组患者术后2例肺不张、1例切口脂肪液化、2例术后咽喉疼痛;HDST组患者术后1例胸腔积液、1例食管空肠吻合口瘘（食管碘水造影检查证实）,经引流及肠内营养治疗后痊愈出院。两组患者均未出现进食困难、反流等并发症。术后所有患者随访1—18个月,中位随访时间为8个月,至随访截止日期患者均生存,无肿瘤局部复发、种植和远处转移。结论两种不同的食管空肠吻合方式均能在腹腔镜下完成,安全有效,使用HDST法可以更快地完成抵钉座的放置。     

Three-Year Follow-Up Study of Retrocolic versus Antecolic Laparoscopic Roux-en-Y Gastric Bypass

Background Since 1994, laparoscopic Roux-en-Y gastric bypass (LRYGBP) has gained popularity for the treatment of morbid obesity. In analogy to open surgery, the operation was initially performed in a retrocolic fashion. Later, an antecolic procedure was introduced. According to short-term studies, the antecolic technique is favorable. In this study, we compared the retrocolic vs the antecolic technique with 3 years of follow-up. We hypothesized that the antecolic technique is superior to the retrocolic in terms of operation time and morbidity. Methods 33 consecutive patients with retrocolic technique and 33 patients with antecolic technique of LRYGBP were compared, using a matched-pair analysis. Data were extracted from a prospectively collected database. The matching criteria were: BMI, age, gender and type of bypass (proximal or distal). The end-points of the study were: operation time, length of hospital stay, incidence of early and late complications, reoperation rates and weight loss in the followup over 36 months. Results In the retrocolic group, operation time was 219 min compared to 188 min in the antecolic group (P = 0.036). In the retrocolic group, 3 patients (9.1%) developed an internal hernia and 4 patients (12.1%) suffered from anastomotic strictures. In the antecolic group, 2 patients (6.1%) developed internal hernias and in 3 patients (9.1%) anastomotic strictures occurred. Median hospital stay in the retrocolic group was 8 days compared to 7 days in the antecolic group. In the antecolic group, the mean BMI dropped from 46 kg/m2 to 32 kg/m2 postoperatively after 36 months. This corresponds to an excess BMI loss of 66%. In the retrocolic group, we found a similar decrease in BMI from preoperative 45 kg/m2 to 34 kg/m2 after 36 months (P = 0.276). Conclusion The results of our study demonstrate a reduction of operation time and hospital stay in the antecolic group compared to the retrocolic group. No differences between the two groups were found regarding morbidity and weight loss. Taken together, the antecolic seems to be superior to the retrocolic technique.     

Anastomotic technique influences outcomes after partial gastrectomy for adenocarcinoma

The proper reconstructive technique after partial gastrectomy for adenocarcinoma of the stomach is often debated, but few data exist to clarify the issue. We evaluated outcomes after different anastomoses used during partial gastrectomy for gastric adenocarcinoma. We reviewed the hospital records of all 277 patients who underwent operation for gastric cancer at our institution from 1970 to 1996. Of 118 partial gastrectomies performed with curative intent 57 anastomoses were Billroth II gastrojejunostomies, 22 were Billroth I gastroduodenal reconstructions, and 39 were Roux-en-Y gastrojejunostomies. There was no difference in the incidence of early gastric emptying problems or early or late postoperative obstruction among the groups. Average hospital stay was 14 days for the Billroth I group, 15 days for those with Billroth II reconstructions, and 22 days for the Roux-en-Y cohort. Documented late gastric outlet obstruction occurred in 29 per cent of patients having Billroth I and in 33 per cent of those with Billroth II anastomoses. Antecolic anastomoses represented 30 (53 per cent) and retrocolic 27 (47 per cent) of the 57 Billroth II reconstructions performed. Late gastric outlet obstructions occurred in seven (23 per cent) patients who had antecolic reconstructions and in just one (4 per cent) with a retrocolic anastomosis (P < 0.05). Five-year cumulative survival was lower for patients having Billroth I reconstructions than for those with Billroth II (P < 0.05). Among patients with Billroth II reconstructions, 5-year cumulative survival was lower for those with antecolic reconstructions compared with those with retrocolic anastomoses (P < 0.05). Although conventional teaching dictates otherwise our data indicate that retrocolic Billroth II anastomoses are preferable to antecolic Billroth II reconstructions after partial gastrectomy for adenocarcinoma of the stomach, as there is a diminished risk of late gastric outlet obstruction and a greater 5-year survival among patients having the former procedure. Survival is unacceptably low after Billroth I anastomoses.     

Laparoscopic antecolic Roux-En-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach

Background  Laparoscopic Roux-en-Y gastric bypass surgery reportedly has a higher rate of postoperative internal hernias than open bypass surgery. Even with closure of mesenteric defects, hernias occur in up to 9% of cases. To minimize this complication, an antecolic antegastric approach to anastomosis of the Roux limb and gastric pouch has been used. Whereas the retrocolic retrogastric technique creates three mesenteric defects, the antecolic approach produces only two: Petersen’s defect and the jejunojejunostomy. The rate of internal hernias was compared among patients undergoing laparoscopic Roux-en-Y gastric bypass surgery using the retrocolic and antecolic approaches. Methods  The experience of a single surgeon from August 2001 to September 2005 was reviewed. Only Roux-en-Y gastric bypass procedures were included. Patients were followed for a minimum of 18 months postoperatively. The retrocolic approach was used for 274 patients and the antecolic approach for 205 patients. All defects were closed at the time of surgery. With the antecolic approach, Petersen’s defect was closed from the root of the mesentery of the Roux limb and the transverse colon mesentery up to the transverse colon. Results  Of the 274 patients, 7 (2.6%) experienced a symptomatic internal hernia with the retrocolic retrogastric technique. No internal hernias were reported among the 205 patients treated with the antecolic antegastric method. Chi-square analysis showed that an antecolic approach was associated with a decreased rate of internal hernias (p < 0.025). Of 479 patients, 35 (7%) underwent diagnostic laparoscopy without any internal hernia found. Of these patients, 15 were found to have cholelithiasis and subjected to laparoscopic cholecystectomy. Conclusions  The antecolic antegastric approach to laparoscopic Roux-en-Y gastric bypass is associated with fewer postoperative hernias than the retrocolic retrogastric approach. The frequency of hernias using either technique is low if meticulous attention is paid to closure of all mesenteric defects. Presented at the 2007 Society of American Endoscopic Surgeons (SAGES) meeting in Las Vegas, SS16: Outcomes, Presentation: S097, Sunday 22 April 2007     

Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial

OBJECTIVE: To determine if an antecolic or a retrocolic duodenojejunostomy during pylorus-preserving pancreaticoduodenectomy (PpPD) was associated with the least incidence of delayed gastric emptying (DGE), in a prospective, randomized, controlled trial. SUMMARY BACKGROUND DATA: The pathogenesis of DGE after PpPD has been speculated to be related to factors such as inflammation, ischemia, gastric atony, motilin levels, and type of surgical procedure. Previous retrospective studies have shown a lower incidence of DGE after antecolic duodenojejunostomy. A prospective trial is needed. METHODS: Forty patients were enrolled in this trial between May 2002 and April 2004. Just before duodenojejunostomy during PpPD, the patients were randomly assigned to undergo either an antecolic or a retrocolic duodenojejunostomy. RESULTS: DGE occurred in 5% of patients with the antecolic route for duodenojejunostomy versus 50% with the retrocolic route (P = 0.0014). Those with the antecolic route had a significantly shorter duration of postoperative nasogastric tube drainage than did those with the retrocolic route (4.2 days versus 18.9 days, respectively, P = 0.047). By postoperative day 14, all patients with the antecolic route could take solid foods, while only 55% (11 of 20) of the patients with the retrocolic route could take solid foods (P = 0.0007). The length of stay in the hospital was 28 days for the antecolic group versus 48 days for the retrocolic group (P = 0.018). CONCLUSIONS: Antecolic reconstruction for duodenojejunostomy during PpPD decreases postoperative morbidity and length of hospital stay by decreasing DGE. Our data suggest that PpPD with antecolic duodenojejunostomy is a safer operation.     

胰管-空肠黏膜对黏膜间断式吻合在腹腔镜胰十二指肠切除术中的应用

目的 探讨腹腔镜胰十二指肠切除术中应用胰管-空肠黏膜对黏膜间断式吻合预防和减少胰瘘的临床效果。方法 回顾性分析2016年3月至2019年6月西安交通大学附属咸阳市中心医院收治的86例行胰十二指肠切除术患者的临床资料,根据不同胰肠吻合方式分为传统吻合组（传统组,45例）和改良胰管-空肠黏膜对黏膜间断式吻合组（改良组,41例）。观察比较两组手术时间、胰肠吻合时间、术中出血量、术后胰瘘发生率和其他并发症、术后住院时间等围手术期指标的差异。结果 两组患者无围手术期死亡,均成功完成预定Whipple手术,全部采用Child消化道重建。术中情况：传统组与改良组术中出血量分别为（410±220）mL、（365±150）mL（t=0.321,P=0.060）,胆肠吻合时间分别为（22±9）min、（23±11）min（t=0.838,P=0.563）,胃肠吻合时间分别为（23±8）min、（22±9）min（t=0.726,P=0.212）,上述指标两组比较无统计学差异;术中胰肠吻合时间分别为（25±10）min、（41±12）min（t=2.512,P=0.032）;总手术时间分别为（240±20）min、（315±25）min（t=5.362,P=0.048）,两组比较有统计学差异,改良组多于传统组。术后情况：传统组A级胰瘘5例、B级胰瘘8例,改良组A级胰瘘1例、B级胰瘘2例（χ2 =3.216,P=0.019）;术后住院时间分别为（15.2±3.2）d、（10.3±1.1）d（t=-1.526,P=0.016）,两组比较有统计学差异,改良组优于传统组。结论 应用改良胰管-空肠黏膜对黏膜间断式吻合,相较于传统的胰肠套入式吻合可以降低胰十二指肠切除术后胰瘘发生率,缩短住院时间,从而改善临床疗效。     

Anastomotic Leak following Antecolic versus Retrocolic Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

Background Laparoscopic Roux-en-Y gastric bypass(LRYGBP) is the most commonly performed operation for the treatment of morbid obesity in the United States. Previous reports suggest that postoperative complications may be influenced by Roux limb orientation (antecolic versus retrocolic), although thisremains controversial. The aim of this study was toanalyze our experience with anastomotic leaks following LRYGBP with an antecolic- versus retrocolicrouted Roux limb. Methods During the 2-year period of June 2003 to June 2005, 353 patients underwent a LRYGBP. 135 were antecolic and 218 retrocolic. All cases were performedby one of three bariatric surgeons. The decisionto perform antecolic versus retrocolic LRYGBP was left to the surgeon’s preference. The primary outcome measure was anastomotic leak. Results Mean follow-up was 28 weeks. There wereno perioperative deaths. Overall complication rate was 16.9%. 17 gastrojejunal leaks (4.8%) were identified, consisting of 12 intraoperative leaks (3.4%) and 5 postoperative leaks (1.4%). Postoperative gastrojejunal leak rate was higher in the antecolic group (P = 0.04). Conclusion Mortality and complication rates were consistent with reported benchmarks on the efficacy and safety of LRYGBP. Our review suggests that anastomotic leak may be more common after antecolic than after retrocolic LRYGBP for morbid obesity. A prospective randomized study is needed to determine whether antecolically-routed Roux limb is an independent predictor for anastomotic leak following LRYGBP.     

Antecolic or retrocolic anastomoses in Billroth II gastrojejunostomy?

A retrospective study of major postoperative morbidity in two groups (50 patients each) that underwent Billroth II gastrectomy for duodenal ulcer disease showed no difference according to the type of anastomosis used (antecolic vs retrocolic). Prevention was not related to the type of anastomosis used, the main means of prevention being the use of meticulous care during the gastrojejunostomy.     

两定点连续缝合技术在后腹腔镜离断式肾盂成形术中的应用

目的比较后腹腔镜离断式肾盂成形术中"两定点连续缝合技术"和"间断缝合技术"的临床应用。方法回顾性分析2011年1月至2014年2月后腹腔镜离断式肾盂成形术107例。根据肾盂输尿管吻合方法分为"两定点连续缝合技术"组27例(A组),"间断缝合技术"组80例(B组)。对总手术时间、肾盂缩窄时间、肾盂输尿管吻合时间、术后住院时间、引流管拔除时间及漏尿等并发症进行比较。结果 A组手术无中转开放;B组2例中转开放。A组和B组总手术时间平均分别为167.7及191.4min(P=0.003);肾盂输尿管吻合时间平均为20.1及41.5min(P0.001);两组肾盂缩窄时间、术后引流管放置时间、术后住院天数比较差异无统计学意义。其中A组围手术期无漏尿病例,B组围手术期漏尿4例。术后3月复查B超提示A组肾积水消失16例,肾积水不同程度减轻11例;B组肾积水消失54例,肾积水不同程度减轻24例。结论后腹腔镜离断式肾盂成形术中采取"两定点连续缝合技术",可以降低输尿管吻合难度、缩短手术时间、减少术后漏尿发生率。     

1＋2胰肠吻合在腹腔镜胰十二指肠切除术中的应用

目的总结1＋2胰肠吻合法用于腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)的经验,探讨其安全性和有效性。 方法回顾性分析包头医学院第二附属医院消化微创中心2016年11月至2018年11月收治并实施LPD患者22例,其中观察组12例采用1＋2胰肠吻合术、对照组10例采用胰管空肠黏膜对黏膜吻合术,观察两组的胰肠吻合时间、手术时间、术中出血量,术后胰漏发生率、再次手术率、术后并发症发生率。 结果22例患者均顺利完成手术。胰肠吻合时间：观察组(32.8±4.2)min、对照组(39.1±7.4)min;手术时间：观察组(295.8±22.6)min、对照组(318.0±24.8)min;术中出血量：观察组(165.0±30.6)ml、对照组(181.0±25.6)ml;术后并发症胰漏：观察组3例(A级胰漏2例、B级胰漏1例、C级胰漏0例),对照组3例(A级胰漏2例、B级胰漏1例、C级胰漏0例);两组胆漏均为1例;两组均无术后出血,均无术后腹腔感染;胃排空障碍：观察组1例、对照组1例;肺部感染：观察组0例、对照组1例;两组均未行二次手术;两组术后30 d内均无死亡。胰肠吻合时间、手术时间两组比较,差异有统计学意义(P<0.05),其余观察指标两组间比较,差异无统计学意义(P>0.05)。 结论采用1＋2胰肠吻合在LPD中应用安全、疗效确切、操作简便,值得临床应用并加以推广。     

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...