中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (07): 816-821.DOI: 10.19538/j.cjps.issn1005-2208.2024.07.19

• 论著 • 上一篇    下一篇

改良Q型荷包缝合包埋法用于腹腔镜胃癌根治术十二指肠残端处理价值研究

孙龙和1,2，王    伟1，周家杰1，伏亚彦1，赵 帅1，李瑞奇1，孙倩男1,3,4，钱春华2，王道荣1,3,4   

  1. 1扬州大学附属苏北人民医院   南京大学医学院教学医院   苏北人民医院普外科，江苏扬州 225001；2泰州市第四人民医院普外科，江苏泰州225300；3扬州大学—扬州市普通外科研究所，江苏扬州 225001；4扬州市消化病/代谢病基础与临床转化重点实验室，江苏扬州 225001
  • 出版日期:2024-07-01 发布日期:2024-07-21

  • Online:2024-07-01 Published:2024-07-21

摘要： 目的    评估腹腔镜胃癌根治术中应用改良Q型荷包缝合包埋法处理十二指肠残端的安全性和有效性。方法    回顾性分析2020年1 月至2023年6月苏北人民医院普外科和泰州市第四人民医院胃肠中心收治的432例行腹腔镜根治性全胃切除术或远端胃切除术病人的临床资料，术中均进行十二指肠残端缝合加强，采用改良Q型荷包缝合包埋法262例（Q型缝合组）和间断缝合包埋法170例（间断缝合组）。比较分析两组病人临床病理特征、围手术期资料和术后并发症情况。结果    两组病人基线资料差异无统计学意义（P>0.05），具有可比性。Q型缝合组在缝合时间［（4.1±1.8）min vs.（9.3±1.4）min，P=0.001］、一次包埋成功率（90.1% vs. 78.1%，P=0.001）、缝合满意度（95.4% vs. 89.9%，P=0.026）方面优于间断缝合组。Q型缝合组病人均未发生十二指肠残端瘘（DSL），间断缝合组2例病人发生DSL，组间差异无统计学意义（P＞0.05）。两组病人均无DSL相关死亡和再手术。两组在其他术后并发症方面差异亦无统计学意义（P>0.05）。结论    改良Q型荷包缝合包埋法加固十二指肠残端操作简单安全，可缩短操作时间、提高一次包埋成功率和缝合满意率，有减少DSL发生的趋势，不增加相关手术风险。

关键词: 改良Q型荷包缝合包埋法, 十二指肠残端瘘, 腹腔镜, 胃癌根治术, 并发症

Abstract: To evaluate the safety and efficacy of the modified Q-type purse-string suture and embedding method for the duodenal stump in laparoscopic radical gastrectomy for gastric cancer. Methods    A retrospective analysis was conducted based on the clinical data of 432 patients who underwent laparoscopic radical gastrectomy for gastric cancer at Subei People's Hospital between January 2020 and June 2023. All patients had duodenal stump reinforcement during surgery. The patients were divided into the Q-type suture group (262 cases) using the modified Q-type purse-string suture and embedding method, and the interrupted suture group (170 cases) using the traditional interrupted suture embedding method. The clinicopathological characteristics, perioperative data, and postoperative complications of the two groups were compared. Results  There were no statistically significant differences in the clinicopathological characteristics between the two groups, making them comparable.The Q-type suture group showed superior performance than the interrupted suture group in purse-string suture time （(4.1±1.8） min vs. （9.3±1.4） min, P=0.001), purse-string suture success rate (90.1% vs. 78.1%, P=0.001), and purse-string suture satisfaction rate (95.4% vs. 89.9%, P=0.026). No patients in the Q-type suture group experienced duodenal stump leakage (DSL), while two patients in the interrupted suture group experienced DSL and the difference was not statistically significant (P>0.05). There were no DSL-related reoperations or deaths in the two groups. No significant differences in other postoperative complications between the two groups were observed (P>0.05). Conclusion    The modified Q-type purse-string suture and embedding method for duodenal stump reinforcement is simple and safe, reduces operation time, improves the success rate and satisfaction rate of purse-string sutures, and tends to lower the incidence of duodenal stump leakage without increasing the risk of related reoperations .

Key words: modified Q-type purse-string suture and embedding method, duodenal stump leakage, laparoscopy, gastric cancer surgery, complications