中国实用外科杂志

中国实用外科杂志

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腹腔镜下不切断空肠 Roux-en-Y吻合在远端胃癌根治术中应用价值研究

杨    力1，徐泽宽1，2 ，徐    皓1，张殿彩1   

  1. 1 南京医科大学第一附属医院胃外科，江苏南京210029  2 南京医科大学肿瘤个体化医学协同创新中心,江苏南京210029
  • 出版日期:2015-10-01 发布日期:2015-10-09

  • Online:2015-10-01 Published:2015-10-09

摘要：

目的    探讨腹腔镜下不切断空肠Roux-en-Y（uncut Roux-en-Y）吻合在远端胃癌根治D1+或D2手术中应用的安全性及可行性。方法    回顾性分析2014年9月至2015年1月南京医科大学第一附属医院胃外科行腹腔镜下uncut Roux-en-Y吻合的18例病人的临床资料。结果    18例病人均在腹腔镜下顺利完成手术。平均手术时间（164.8±23.1）min，吻合时间（31.4±7.1）min；术中平均出血量（19.1±9.0）mL；平均清扫淋巴结（37.0±8.5）枚。术后胃肠功能恢复时间（70.6±17.9）h，下床活动时间（46.2±17.3）h，进流食时间（4.9±0.8）d，术后平均住院（10.2±3.0）d；2例发生消化道出血并发症，均保守治愈，无吻合口瘘、吻合口狭窄、Roux滞留综合征（Roux stasis syndrome，RSS）及切口感染并发症。结论    腹腔镜下uncut Roux-en-Y吻合在远端胃癌根治手术中安全可行，具有创伤更小、恢复更快等优点。

关键词: 胃癌, 腹腔镜, 胃切除术, uncut Roux-en-Y 吻合

Abstract:

Total laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D1+ or D2 dissection for gastric cancer        YANG Li*,  XU Ze-kuan,  XU Hao, et al. *Division of Gastric Surgery, Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing210029, China
Corresponding author: XU Ze-kuan, E-mail: xuzekuan@njmu.edu.cn
Abstract    Objective    To investigate the safety and feasibility of laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D1+ or D2 dissection for gastric cancer. Methods    The clinical data of 18 patients performed laparoscopic uncut Roux-en-Y anastomosis from September 2014 to January 2015 in the Division of Gastric Surgery, Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. Results    All the patients were performed the operation successfully. The mean operation duration, anastomosis time, blood loss and the number of lymph nodes dissection during the surgery were (164.8±23.1) min, (31.4±7.1)min, (19.1±9.0)mL and 37.0±8.5 respectively. The time cost before gastrointestinal motility, liquid-diet intake, out-of-bed ambulation and the average hospitalization days after operation were (70.6±17.9) hours, (4.9±0.8) days, (46.2±17.3) hours and (10.2±3.0) days respectively. Two patients suffered from gastrointestinal bleeding and were cured conservatively. None of the other complications occurred, such as anastomotic fistula, anastomotic stenosis, RSS, infection of incision and so on. Conclusion    The total laparoscopic uncut Roux-en-Y anastomosis is safe and feasible in the distant gastrectomy with D1+ or D2 dissection for gastric cancer, with advantages of less trauma, faster recovery and so on.

Key words: gastric cancer, laparoscopy, gastrectomy, uncut Roux-en-Y anastomosis