腹腔镜胃癌根治残胃或食道与空肠双襻加侧侧吻合术经验

探讨腹腔镜胃癌根治术残胃或食道空肠双襻加侧侧吻合术的临床疗效。 方法回顾性分析2012年1月至2018年9月施行腹腔镜根治性全胃切除行食道与空肠双襻吻合空肠与空肠侧侧吻合重建方式45例；远端胃大部切除行残胃与空肠双襻空肠与空肠侧侧吻合重建方式71例，共116例病人的临床资料分析。 结果116例患者均顺利完成腹腔镜胃癌根治术，无中转手术。术后发生胃排空障碍3例(2.6%)，经有效胃肠减压，放置营养管支持等保守治疗5～21 d胃排空障碍解除。45例食道与空肠双襻空肠与空肠侧侧吻合重建方式无排空障碍发生。本组发生肺部感染6例(5.2%)、经治疗感染得到控制；发生脑血栓1例(0.8%)，经积极有效对症治疗病情稳定；发生房颤4例(3.4%)，经对症治疗缓解，无围手术期死亡。术后116例病人随访时间截止2018年9月(6 ～109个月)，术后肿瘤复发4例(3.4%)。 结论腹腔镜胃癌根治术残胃或食道空肠双襻加侧侧吻合术，可有效降低术后并发症发生率，加速病人快速康复，其术后消化吸收功能和病人生活质量较好。

Laparoscopic distal or total gastrectomy with Braun anastomosis,report of 116 cases

ObjectiveTo investigate the clinical outcome of laparoscopic distal or total gastrectomy with Braun anastomosis for gastric cancer. MethodsFrom January 2012 to September 2018, clinical data of 116 patients were analyzed retrospectively, including 45 patients received laparoscopic radical total gastrectomy with Braun anastomosis, and 71 patients underwent distal gastrectomy with with Braun anastomosis. ResultsAll of 116 patients received successful laparoscopic surgery without conversion. Gastric emptying disorder occurred in 3 cases (2.6%) after operation. After sufficient gastrointestinal decompression, nutrition support from nasojejunal feeding tube and other conservative treatment, the gastric emptying disorder were relieved ranging 5~21 days. There was no emptying disorder in 45 cases of total gastrectomy with Braun anastomosis. There were 6 cases (5.2%) of pulmonary infection, which were cured by antibiotic treatment, 1 case (0.8%) of cerebral thrombosis and 4 cases (3.4%) of atrial fibrillation, which were alleviated by symptomatic treatment without perioperative death. The follow-up period of 116 patients ended September 2018 (6~109 months). Four patients (3.4%) had recurrence after operation. ConclusionLaparoscopic total gastrectomy with Braun anastomosis could effectively reduce the incidence of postoperative complications, accelerate the rapid recovery of patients, and have better digestive and absorption function and quality of life.