腹腔镜远端胃癌根治毕Ⅱ式吻合不同缝合方式的疗效分析

Different suture methods in laparoscopic radical resection of distal gastric cancer with Billroth Ⅱ anastomosis

目的对比应用吻合器行胃肠吻合后行不同方式加强缝合,吻合口在腹腔镜下胃远端癌根治术的近期疗效。方法回顾性分析2008年6月至2013年10月同一治疗组采用腹腔镜下胃远端癌根治术BillrothⅡ式吻合病例的临床资料。胃肠吻合后行吻合腔内加强缝合组113例,吻合腔外加强缝合组115例,未加强缝合组53例;对比观察三组方式的围手术期情况。采用SPSS 17.0软件进行统计学处理,总手术时间、术中出血量、术后下床时间、肛门恢复通气时间、进食半流质时间、住院时间的组间比较采用t检验,三组患者术后并发症及病死率的比较采用χ2检验或Fisher确切概率法检验,P<0.05有统计学意义。结果三组患者术中出血量、总手术时间、术后下床时间、肛门恢复通气时间、进食半流质时间、住院时间、住院费用差异均无统计学意义(P>0.05);腔内缝合组和腔外缝合组及未缝合组术后总并发症发生率分别为12.4%(14/113)、12.2%(14/115)和22.6%(12/53),差异不具有统计学意义(P=0.226);未缝合组吻合口出血发生率显著高于其他2组,χ2=7.046,P=0.03。结论腹腔镜胃远端癌根治术应用吻合器行胃肠吻合后行手工加强缝合吻合口可降低术后并发症,增加手术的安全性。

Objective To investigate the short-term clinical outcome of different suture methods after gastrointestinal anastomosis in laparoscopic radical resection of distal gastric carcinoma. Methods The clinical data of patients with distal gastric cancer treated by laparoscopic radical resection with Billroth 1I anastomosis from June 2008 to October 2013 were analyzed retrospectively. There were 113 cases of lumen strengthening suture after gastrointestinal anastomosis, 115 cases of cavity outside stiengthening suture and 53 cases of no strengthening suture. Operation time, intraoperative blood loss, postoperative ambulation time, anus ventilation time, time of semifluid food intake and length of hospital stay were analyzed using SPSS 17.0 software and examined Student＇ s t test, whereas the rate of postoperative complications and mortality were analyzed using the Chi-square test or Fisher＇ s exact test （ P 〈 0.05 ）. Results There was no significant difference between the three groups in intraoperative blood loss, total operation time, postoperative ambulation time, anus ventilation time, time of semi-fluid food intake, length of hospital stay and hospital cost （P 〉 0.05 ）. The total postoperative complication rates of the Lumen suture group and cavity stitched and unstitched group were 12.4% （14/113）, 12.2% （14/115） and 22.6% （12/53） respectively （P = 0.226）. The incidence of anastomotic bleeding was higher in the unstitched group than in the other two groups ^（2 = 7. 046, P = 0.03）. Conclusion Strengthening suture of gastrointestinal anastomosis could reduce postoperative complications in laparoscopic radical resection of distal gastric cancer, and could increase the safety of surgical operation.