Delta吻合在完全腹腔镜远端胃大部切除术中的应用

目的回顾分析完全腹腔镜远端胃大部切除术Delta吻合的安全性和有效性。方法2011年4月-2014年5月，15例患者因胃癌行完全腹腔镜根治性远端胃大部切除术并采用Delta吻合完成胃十二指肠吻合。统计手术时间、吻合口瘘、吻合口出血、狭窄等并发症；淋巴结清扫数目，病灶和近、远端切缘间距离，随访生存情况。结果15例手术没有中转开腹病例，平均手术时间（274．9±55．5）min，Delta吻合平均耗时（32．6±4．9）min。没有吻合El瘘，1例患者在术后第10天、辅助化疗第2天上消化道出血，经保守治疗治愈。1例患者术后3个月吻合口狭窄，经保守治疗缓解。平均每例清扫（23．0±7．8）枚淋巴结，无阳性切缘，肿瘤距近、远侧切缘平均距离分别为（5．8±2．6）cm和（3．8±2．1）cm。1、3年累积生存率分别为92％、83％。结论Delta吻合操作简便、安全可靠，是胃窦部和胃体下部胃癌完全腹腔镜手术可供选择的消化道重建方法。

Feasibility of Delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for patients with gastric cancer,a retrospective analysis

Objective To evaluate the feasibility of Delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for patients with distal gastric cancer. Methods Fifteen patients with gastric cancer were treated with totally laparoscopic distal gastrectomy, and Delta-shaped gastroduodenostomies were performed for the reconstruction of gastrointestinal continuity. The medical records were reviewed retrospectively, the dmations of operation and the Delta- shaped gastroduodenostomy were calculated. Occurrence of severe complications such as anastomosis insufficiency, bleeding and stenosis, the number of lymph nodes were retrievaled, the distances between the margin of gastric cancer and the distal or proximal margins were recorded. The patients were follow upped and the 1 and 3-year cumulated overall survival rate were calculated. Results All the patients were treated with totally laparoscopic gastrectomy, without conversion to open surgery. The average duration of operation was （274.9 ± 55.5 ） min and the Delta- shaped anastomosis cost about （32.6±4.9） rain. There was no anastomosis insufficiency occurred. One patient suffered upper gastrointestinal hemorrhage on postoperative day 10 （one day after the initiation of adjuvant chemotherapy）. Anastomotic stenosis occurred in one patient three months after operation. Both patients were treated conservatively with an uneventful course. Averagely （23.0 ± 7.8 ） lymph nodes were tetrievaled for each patient. There was no positive margin, the proximal and distal distance between the focus and the resection line were （5.8±2.6） cm and （ 3.8 ± 2.1 ） cm respectively. The cumulated one and 3- year overall survival rates were 92% and 83% respectively. Conclusions The Delta-shaped gastroduodenostomy was a safe and effective way for the reconstruction of gastrointestinal continuity in totally laparoscopic distal gastrectomy.