三角吻合在完全腹腔镜远端胃癌根治术中的应用研究

Application study of totally laparoscopic distal gastrectomy with delta-shaped anastomosis

目的 对比分析远端胃癌根治术中全腹腔镜下三角吻合与腹腔镜辅助Brillroth Ⅰ式吻合的近期疗效,探讨三角吻合技术的应用价值.方法 回顾性分析2013年3月至2014年2月开展的50例全腹腔镜下远端胃癌根治术加三角吻合的临床资料（三角吻合组）,并以同期开展的43例腹腔镜辅助远端胃癌根治术加Brillroth Ⅰ吻合作为对照（BⅠ吻合组）,比较两组患者的手术相关指标和术后并发症发生情况.结果 两组手术时间、术中出血量、淋巴结清除数、术后肛门排气时间、并发症发生率和术后住院天数比较,差异均无统计学意义（均P＞0.05）;三角吻合组切口长度[（3.4±0.4）cm]和术后第1天疼痛评分[（3.1±1.0）]小于BⅠ吻合组[（6.9±0.8）cm和（4.6±1.4）],差异均有统计学意义（均P＜0.05）.结论 全腹腔镜下远端胃癌根治术三角吻合技术安全可行,在切口美观和舒适度方面较腹腔镜辅助下Brillroth Ⅰ式吻合更有优势。

Objective To compare the short-term efficacy between totally laparoscopic distal gastrectomy （TLDG） with delta-shaped anastomosis （DS） and laparoscopic-assisted distal gastrectomy （LADG） with Brillroth Ⅰ anastomosis （B Ⅰ）,and to evaluate the application of DS.Methods Between March 2013 and February 2014,50 patients underwent TLDG with DS using linear staplers,and 43 patients underwent LADG with B Ⅰ using circular staplers.Clinical features and short-term efficacy of the two groups were analyzed retrospectively.Results There were no significant differences between the two groups in terms of demographic indicators,operation time,intraoperative blood loss,number of removal lymph node,time to first flatus,incidence of complication and postoperative discharge day（all P〉 0.05）.First-day postoperative pain was milder （3.1 ±1.0 vs.4.6±1.4）,and operative incision was shorter [（3.4±0.4） cm vs.（6.9±0.8） cm] significantly in TLDG with DS group（P〈0.05）.Conclusion TLDG with DS is safe and feasible for patients with gastric cancer,and has more advantages in cosmetic and comfort level than LADG with B Ⅰ.