腔内外加固缝合在腹腔镜辅助胃癌消化道重建中的应用

Clinical application of internal or external reinforcement suture in gastrointestinal reconstruction after laparoscopic assisted radical gastrectomy for gastric cancer

目的探索腹腔镜胃癌手术器械吻合后加固缝合方法,比较不同方法安全性及短期效果.方法回顾性分析2008-06/2016-06长江大学附属第一医院胃肠外科行腹腔镜辅助远端胃癌根治术BillrothⅡ式胃肠吻合327例患者的临床资料.胃肠吻合后腔内加固缝合组119例,腔外加固缝合组155例,未加固缝合组53例;对比观察3组手术的总手术时间、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、术后住院时间.采用SPSS17.0软件进行统计学处理,住院时间的组间比较采用t检验,3组患者术后并发症及病死率的比较采用?2检验或Fisher确切概率法检验,P<0.05为差异有统计学意义.结果3组患者在术中出血量、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并发症发生率分别为13.4%(16/119)、9.0%(14/155)和22.6%(12/53),差异不具有统计学意义(P=0.121);未缝合组吻合口出血显著高于其他2组(?2=7.046,P=0.03);未缝合组吻合口瘘高于其他2组,但差异无统计学意义(?2=6.130,P=0.05).结论腹腔镜辅助胃远端癌根治术应用吻合器行BillrothⅡ式吻合后手工加固缝合吻合口可降低术后吻合口出血并发症,增加手术的安全性.

AIM To compare the short-term curative effect and safety of different ways to strengthen the suture line of gastrointestinal anastomosis in gastrointestinal reconstruction after laparoscopic assisted radical gastrectomy for gastric cancer.METHODS A retrospective analysis was performed of the clinical data for 327 gastric cancer patients who underwent radical gastrectomy with BillrothⅡ reconstruction from June 2008 to June 2016,including 119 cases with internal reinforcement after gastrointestinal anastomosis,155 cases with external reinforcement,and 53 cases without reinforcement.Total operative time,intraoperative blood loss,time to ambulation,time to anal exhaust,time to intake of semifluid food,and length of hospital stay were compared by t-tests between different groups.Postoperative complications and mortality were compared using χ^2 test or Fisher＇s exact probability method.RESULTS Total operative time,intraoperative blood loss,time to ambulation,time to anal exhaust,time to intake of semifluid food,and length of hospital stay had no statistical differences between the three groups（P〉0.05）.The total postoperative complication rates of the internal reinforcement,external reinforcement and non-reinforcement groups were 13.4%（16/119）,9.0%（14/155） and 22.6%（12/53）,respectively,and there was no statistically significant difference between the groups（P= 0.121）.The non-reinforcement group had a significantly higher incidence of anastomotic bleeding than the other two groups（χ^2 =7.046,P = 0.03）.The non-reinforcement group had a higher incidence of anastomotic fistula than the other two groups,but there was no statistically significant difference（χ^2 = 6.130,P = 0.05）.CONCLUSION The application of internal or external reinforcement after gastrointestinal anastomosis in laparoscopic assisted radical gastrectomy for GC can reduce the incidence of postoperative complications and increase surgical safety.