Delta吻合在完全腹腔镜下远端胃癌切除术中的应用

Delta-shaped anastomosis in total laparoscopic distal gastrectomy

目的分析完全腹腔镜下远端胃癌切除后delta吻合的可行性及技术要点。方法82例远端胃癌患者接受腹腔镜下根治切除，根据消化道重建方式分为体内吻合和体外吻合两组，其中39例采用腔镜下体内delta吻合，43例通过腹部小切口进行体外BillrothI式消化道重建。结果体内组平均吻合时间长于体外组，差异有统计学意义[（17±8）min比（12±3）min，t=2．529，P〈0．05]；体内组与体外组平均手术时间分别为（215±24）rain、（207±13）min，平均出血量分别为（56±21）ml、（65±26）ml，两组相比差异均无统计学意义（t=0．406、1．441，均P〉0．05）。结论在掌握一定的手术技巧情况下，腹腔镜下根治性远端胃癌切除并采用直线切割缝合器完成胃十二指肠delta吻合是安全、简单可行的。

Objective To explore the feasibility of laparoscopically intracorporeal delta-shaped anastomosis in distal gastrectomy. Methods 82 consecutive patients with distal gastric cancer received laparoscopic distal gastrectomy, including intracorporeal delta-shaped anastomosis in 39 cases, and handassisted Billroth-I anastomosis in 43 cases. The operative time, blood loss, anastomosis time were compared between the two groups. Results There were no differences between the two groups with regard to the operative time [ （215±24） min vs. （ 207 ± 13 ） min, t = 0. 406, P 〉 0.05 ] and blood loss [ （ 56± 21 ）ml vs. （65±26）m], t = 1. 441, P 〉 0.05 ], although the intracorporeal Delta-shaped anastomosis was more time-consuming than the extracorporeal Billroth- I anastomosis [ （ 17 ± 8 ） min vs. （ 12 ± 3 ） rain, t = 2. 529, P 〈 0. 05 ] . Conclusions Demanding expertise and some skills, totally laparoscopic distal gastrectomy with intracorporeal delta-shaped anastomosis is safe and feasible.