腹腔镜辅助下远端胃切除术中及术后早期并发症的原因和处理

Causes and management of intraoperative and early postoperative complications of laparoscopy-assisted distal gastrectomy

目的:探讨腹腔镜辅助下远端胃切除(LADG)术中及术后早期并发症的原因与处理。方法:回顾性分析2007年1月—2011年9月82例行LADG术患者的临床资料。结果:中转开腹2例,术中出血6例,皮下气肿3例,高碳酸血症2例,横结肠系膜损伤4例;术后腹腔内出血2例,戳孔感染2例,戳孔血肿1例,十二指肠残端瘘4例,吻合口瘘1例,吻合口狭窄1例,吻合口出血1例,淋巴瘘1例。术中及术后并发症均经处理后痊愈。全组无死亡病例。结论:LADG手术并发症的发生与其手术难度以及术者的经验、技能有关,严格规范操作,提高术者技能和熟练度并加强手术团队的协调、配合是减少LADG术中和术后早期并发症的关键。

Objective： To investigate the causes of the intraoperative and early postoperative complications of laparoscopy-assisted distal gastrectomy （LADG） and their management. Methods： The clinical data of 82 patients undergoing LADG from January 2007 to September 2011 were analyzed retrospectively. Results： Two cases were converted to open surgery and the intraoperative complications included six cases of intraoperative bleeding, three cases of subcutaneous emphysema, two cases of hypercapnia and four cases of transverse mesocolon injury. The postoperative complications comprised of two cases of intra-abdominal bleeding, two cases of port-site infection, one case of port-site hematoma, four cases of duodenal stump leakage, and one case each of anastomotic leakage, anastomotic stenosis, anastomotic bleeding and lymph leakage. All the intra- and postoperative complications were resolved by proper management and no death occurred. Conclusion： The surgical difficulties of LADG and the inexperienced or novice operators are responsible for the majority of the LADG complications The avoidance of the intra- and postoperative complications of LADG requires not only performing the standard operating procedure strictly, but also improving the skill and proficiency of the operators as well as enhancing the coordinated cooperation of the surgical team.