Delta吻合在全腹腔镜远端胃癌根治术Billroth-Ⅰ重建的应用

Application of delta-shaped anastomosis in billroth-Ⅰ reconstruction of totally laparoscopic distal gastric cancer radical operation

目的探讨Delta吻合术在完全腹腔镜下远端胃癌根治术（TLDG）Billroth-Ⅰ重建的安全性及近期疗效。方法回顾性分析2014年1-12月于该院胃肠外科分别行TLDG术Delta吻合（TLDG组,35例）与腹腔镜辅助远端胃癌根治术（LADG）腹腔外吻合（LADG组,35例）的患者临床资料,比较两组患者的术中出血量、手术时间、胃肠功能恢复时间、住院时间、术后病理结果及住院总费用等临床指标。结果 70例患者手术均顺利完成,无中转开腹,无死亡病例。TLDG组术后均未发生吻合口瘘、出血及狭窄;LADG组术后出现1例胃瘫、1例吻合口出血、2例吻合口瘘。两组患者术中出血量、肿瘤大小、淋巴结清扫数及远、近端切缘距离比较,差异均无统计学意义（P〉0.05）;TLDG组手术时间、消化道重建时间、第1次通气时间、进食流质时间及术后住院时间均较LADG组短,住院总费用较LADG组高,差异均有统计学意义（P〈0.05）。结论 Delta吻合技术应用于LADG是安全可行的,并有较好的近期效果。

Objective To evaluate the safety and short-term efficacy of delta-shaped anastomosis in the Billroth-Ⅰ reconstruction of totally laparoscopic distal gastric cancer radical operation（TLDG）.Methods The clinical data in 35 patients with TLDG Delta anastomosis（TLDG group）and 35 patients with laparoscopic assisted distal gastric cancer radical operation（LADG）extraperitoneal anastomosis（LADG group）in the gastroenterology department of our hospital from January to December 2014 were analyzed retrospectively.The intraoperative bleeding volume,operative time,gastroenterological function recovery time,hospitalization duration,postoperative pathological examination results and hospitalization total cost were compared between the two groups.Results Seventy cases successfully completed the operation without the cases of conversion to laparotomy and death.The TLDG group had no anastomotic leakage,bleeding and stenosis after operation;while the LADG group had 1case of gastroparesis,1case of anastomotic bleeding and 2cases of anastomotic leakage.The introperative bleeding volume,tumor size,number of lymph nodes dissection and distant and proximal incisal margin distance had no statistically significant differences between the two groups（P〈0.05）;the operation time,digestive tract reconstruction time,first exhaustion time,time taking liquid diet and postoperative hospital stay time in the TLDG group were significantly shorter than those in LADG group（P〈0.05）,but the hospitalization cost was higher than that in the LADG group,the differences were statistically significant（P〈0.05）.Conclusion The delta-shaped anastomosis technique is safe and feasible for using in LADG,moreover has better short-term effect.