腹腔镜胃癌根治残胃或食道空肠双襻吻合的临床分析

Double-loop anastomosis of gastrointestinal reconstruction in laparoscopic radical resection of gastric cancer

目的探讨腹腔镜胃癌根治术残胃或食道空肠双襻吻合的临床疗效。方法回顾性分析2008年3月至2014年12月对18例腹腔镜胃癌根治术残胃或食道空肠双襻吻合重建术患者的临床资料。行根治性全胃切除术8例，远端胃大部切除术10例。从腹腔镜腹部手术时间、术中出血量、淋巴结清扫数目、术后肛门排气时间、术后住院时间，术后并发症发生率、术后胃排空功能、3年局部肿瘤复发率等评价手术质量。采用门诊和电话方式进行随访，随访时间至2015年3月。结果18例患者均成功实施腹腔镜胃癌根治术。全胃切除术平均238min，远端胃切除术217min。术中平均出血量180ml，平均清扫淋巴结16枚。术后肠蠕动恢复、肛门排气时间平均为3．6d，平均术后住院时间为12．6d。残胃与空肠双襻、空肠与空肠侧侧吻合重建方式，术后发生胃排空障碍2例（11．1％），经有效胃肠减压，营养支持等保守治疗5—12d胃排空障碍解除。无手术切缘癌残留，无围手术期死亡。术后18例患者随访时间截止2015年3月（3—84个月），无肿瘤复发和转移，术后患者生活质量较好。结论腹腔镜胃癌根治术残胃或食道空肠双襻圆形吻合器吻合术安全、可行，术后恢复快和并发症少，术后能维持较好消化吸收功能，其近期效果比较满意，远期效果待进一步观察。

Objective To assess the clinical outcome of double-loop anastomosis of gastrointestinal reconstruction in laparoscopic radical resection of gastric cancer. Methods The clinical data of 18 patients with gastric cancer who had been treated from March 2008 to December 2014 were analyzed retrospectively. These patients underwent a double-loop anastomosis of gastrointestinal reconstruction in laparoscopic resection of gastric cancer, including total gastrectomy for 8 patients and distal subtotal gastrectomy for 10 patients. Their clinical data included operation time, intraoperative blood loss, number of harvested lymph nodes, recovery of bowel movement, hospital stay, postoperative complications, gastrointestinal function and 3-year local recurrence rate. The patients were followed up at the out-patient clinic or by telephone until March 2015. Results The 18 patients were operated upon successfully, with an average of 238 minutes for total gastrectomy and 217 minutes for distal subtotal gastrectomy. The average intraoperative blood loss was 180 ml and a total of 16 positive lymph nodes were detected. Postoperative gastric emptying dysfunction in 3 patients was treated conservatively. No positive resection margin and perloperative death were found and their hospital stay was 12.6 days. Conclusion Laparoscopic radical resection of gastric cancer by double-loop anastomosis of gastrointestinal reconstruction is feasible, with rapid recovery, less complications and satisfactory short-term clinical outcome. The Long-term clinical outcome of this procedure needs further investigation.