全腹腔镜胃癌根治胃十二指肠三角吻合术近期疗效分析

Short-term results of delta-shaped gastroduodenostomy combined with totally laparoscopic distal gastrectomy for distal gastric cancer

目的探讨全腹腔镜胃癌根治胃十二指肠三角吻合术在远端胃癌根治中的应用价值及安全性。方法回顾性分析2013年5月至2014年8月行全腹腔镜下远端胃癌根治胃十二指肠三角吻合术患者50例（三角吻合组）,和同期剖腹远端胃癌根治BillrothⅠ吻合术患者52例（开腹组）,所有患者均接受同一组医师手术,对比两组患者手术的近期疗效,采用SPSS17.0软件进行统计学分析。两组手术时间、术中出血量、肿瘤大小、肛门排气时间、住院费用、术后住院时间等用均数±标准差（x珋±s）表示,采用t检验;病理特征和并发症发生率计数资料比较采用χ^2检验,以P0.05）。术后并发症比较,开腹组术后总并发症发生率为26.9%（14/52）,明显高于胃三角吻合组8.0%（4/50）（χ^2=5.046,P=0.025〈0.05）;两组患者病理特征包括肿瘤大小、组织学分级、Lauren分型、淋巴结转移、T分期、N分期、TNM分期无统计学意义。术后近期情况对比中,三角吻合组平均肛门排气时间（2.9±0.9）d,短于开腹组（t=-10.783,P〈0.05）,术后平均住院（9.9±0.9）d,较开腹组短（t=-12.092,P〈0.05）,但住院费用上三角吻合组较开腹组多（t=17.046,P〈0.05）,以上差异有统计学意义。结论腹腔镜胃癌根治胃十二指肠三角吻合术在远端胃癌根治中安全可行,具有创伤小、出血少、恢复快等优点,其手术近期效果并不劣于开腹手术,远期疗效有待进一步观察。

Objective To assess the value of totally laparoscopic distal gastrectomy combined with delta-shaped gastroduodenostomy for distal gastric cancer. Methods The clinical data of 102 patients who underwent radical gastrectomy in the Surgical Oncology of Peace Hospital Affiliated to Changzhi Medical College were analyzed retrospectively. In this series,50 patients received delta-shaped gastroduodenostomy（ delta-shaped group）,and 52 patients received laparotomy（ laparotomy group）. All operations were performed by a team of surgeons,and the short-term results were compared between the two groups. SPSS17. 0 was used for data analysis. Measurement data including operation time,intraoperative blood loss,tumor size,anal exhaust time,cost of hospitalization and postoperative hospital stay in the two groups were represented as mean ± SD and assessed with Student ＇s t test. The count data including pathological characteristics and the incidence of complications were compared by the Chi-square test. P 〈 0. 05 was considered statistically significant. Results The patients in the delta-shaped group were operated on successfullywithout the need to have open or laparoscopy-assisted operation,and no death occurred. The average operation time was（ 211 ± 17. 5） min in the delta-shaped group,which was significantly longer than that（ 160 ± 12. 5） min in the laparotomy group（ t = 13. 027,P 〈 0. 05）. The average intraoperative bloodloss in the delta-shaped group was（ 113. 1 ± 23. 6） ml which was significantly less than that in the laparotomy group（ 151. 4 ± 24. 1） ml（ t =- 6. 304,P 〈 0. 05）. After operation,the incidence of the whole complications was higher in the laparotomy group（ 26. 9%） than that in the delta-shaped group（ 8. 0%）（ χ~2= 5. 046,P = 0. 025 0. 05）. The pathological characteristics in the two groups including tumor size,histology grade,Lauren type,lymph node metastasis,T stage,N stage,and TNM stage were not statistically significant（ P 〈 0. 05）. After operation,the mean anal exhaust time was（ 2. 9 ± 0. 9） d in the delta-shaped group,which was shorter than that in the laparotomy group（ t =- 10. 783,P 〈 0. 05）. The mean postoperative hospital stay was（ 9. 9 ± 0. 9） d,which was also shorter than that in the laparotomy group（ t =- 12. 092,P 〈 0. 05）,while the hospitalization costs were higher in the delta-shaped group（ t = 17. 046,P 〈 0. 05）. Conclusion Delta-shaped anastomosis is safe and feasible in the reconstruction of the digestive tract during full laparoscopic distal gastrectomy,with a minimum trauma and few blood loss,but a rapid recovery. The results this operation seems to be better than those of laparotomy.