H形吻合在腹腔镜下远端胃癌根治术中的应用

目的:评价H形吻合在腹腔镜下远端胃癌根治术后消化道重建中的临床效果。方法:回顾分析2013年1月至2015年6月152例行腹腔镜下远端胃癌根治术且有完整随访资料患者的临床资料,根据其消化道重建方式分为:H形吻合组(n=20)、毕Ⅰ式吻合组(n=53)、毕Ⅱ式吻合组(n=58)及Roux-en-Y吻合组(n=21)。4组患者在年龄、性别、肿瘤大小、肿瘤分期及分级方面差异均无统计学意义。结果:H形吻合组手术时间及重建时间较毕Ⅰ式有所增加,且重建时间两者差异有统计学意义,与毕Ⅱ式吻合组差异无统计学意义,较Roux-en-Y吻合组明显缩短,差异有统计学意义;H形吻合组术中出血量少于毕Ⅰ式吻合组,差异有统计学意义。术后每日胃肠减压量、术后进流质饮食时间明显少于其他三组,差异有统计学意义。H形吻合组术后排气时间明显缩短,与Roux组相比差异有统计学意义。H形吻合组无术后吻合口狭窄、出血、吻合口漏等并发症发生。结论:H形吻合能明显降低手术时间,减少术后排气时间、胃潴留、吻合口梗阻等并发症,是远端胃癌根治术后理想的消化道重建方式。

Application of H reconstruction in laparoscopic distal gastrectomy for gastric cancer

Objective:To evaluate the clinical efficacy of H reconstruction in digestive tract reconstruction after laparoscopic distal gastrectomy for gastric cancer.Methods:Clinical data of 152 patients who underwent laparoscopic distal gastrectomy for gastric cancer with complete follow-up data between Jan.2013 and Jun.2015 were retrospectively analyzed.Patients were divided into H group (20 cases with H reconstruction),BⅠgroup (53 cases with BillrothⅠreconstruction),BⅡgroup (58 cases with modified BillrothⅡreconstruction) and Roux-en-Y group (21 cases with Roux-en-Y reconstruction) according to reconstructive methods.The differences of age,sex,size,stage and grade of tumors in the four groups were not statistically significant.Results:The reconstruction time in the H group was longer than that in the BⅠ group,shorter than that in the Roux-en-Y group with statistically significant difference,and the difference was not statistically significant compared with the BⅡgroup.The intraoperative blood loss in the H group was less than that in the BⅠgroup.There were fewer gastrointestinal drainage per day and the shorter time to eat liquid diet in the H group compared with those in the other three groups with statistically significant difference.The time of postoperative exhaust was shorter in the H group than that in the Roux-en-Y group.No complications occurred such as anastomotic stenosis,bleeding or leakage in the H group.Conclusions:The H reconstruction can reduce the time of operation,postoperative exhaust time,complications such as gastric retention and anasto-motic obstruction.It may be the preferred technique for reconstruction after laparoscopic distal gastrectomy of gastric cancer.