生物可分解吻合环在全胃切除术中消化道重建的临床应用研究

A study for clinical application of BAR in the reconstruction of alimentary tract after total gastrectomy

目的评价生物可分解吻合环(biaframentable anastomosis ring,BAR)在胃癌全胃切除术中消化道重建的临床应用价值。方法将42例待作全胃切除术的恶性胃肿瘤病人随机分成二组,其中应用BAR作消化道重建21例(BAR组),用传统手工吻合的21例(TMA组)。结果两组病人均无死亡,痊愈出院。BAR组的消化道重建耗时明显少于TMA组。术后情况如吻合口出血、肠功能恢复时间、肺部感染显示BAR组明显好于TMA组。BAR组无吻合口漏,而TMA组则有1例。在术后6个月获得随访中ABR组是20例,TMA组17例。胃镜检查显示:BAR组在术后吻合口狭窄、吻合口炎、吻合口炎和吻合口肉芽肿的发生率均低于TMA组。两组在上述多项指标显示有显著性差异(P<0.05或0.01)。结论应用BAR于全胃切除术的消化道重建具有操作简便快捷、疗效好及术后并发症少等优点,值得在临床推广应用。

Objective To investigate the value of biofragmentable anastomosis ring（BAR）in the reconstruction of alimentary tract after total gastrectomy for gastric carcinoma. Methods 42 cases with gastric carcinoma received tatal gastrectomy were randomly divided into two groups. Among them,21 cases underwent reconstruction of alimentary tract with BAR after total gastrectomy （BAR group） and another 21 cases underwent traditional manual anastomosis （TMA group）. Results There was on death in two groups after operation and all cases were cured to disehorge from hospital. In the operative time of the reconstruction of alimentary tract, the BAR group was obviously less than that TMA group. In the postoperative complications, Such as anastomotic bleeding and pulmonary infection, the BAR group was obviously less than that TMA group. Acquired follow up was 20 and 17 cases in the BAR group and TMA group respectively. 6 months after operation. The gastroseopy show： in the postoperative incidences of anastomotic stenosis, anastomotic ulear, anastomotic inflammation and anastomotic granuloma, the BAR group was obviously lower than that TMA group. Mentioned above multi-index revealed that there was significant difference between two groups （P 〈 0.005 or 0.01 ）. Conclusion When the BAR is used in the reconstruction of alimentary trast after total gastrectomy, it has simple manipulation, good therapeutic efficacy and less postoperative complications. Thus it may be consider as promoted use.