中国实用外科杂志

中国实用外科杂志

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机器人全胃切除术消化道重建吻合方法回顾性对照研究

刁艳青，汪志明，江志伟，王    刚，刘    江，赵    健   

  1. 南京军区南京总医院全军普通外科研究所，江苏南京210002
  • 出版日期:2016-09-01 发布日期:2016-08-24

  • Online:2016-09-01 Published:2016-08-24

摘要：

目的    比较机器人系统行胃癌全胃切除术中采用可吸收线连续缝合与免打结自固定缝线连续缝合两种镜下吻合方法的安全性、可行性及难易程度。方法　回顾性分析南京军区南京总医院2012年4月至2015年4月由同一术者实施达芬奇手术机器人胃癌全胃切除、全镜下消化道重建57例病人临床资料。按吻合方式分为可吸收线连续缝合组（A组，n=35）和免打结自固定缝线连续缝合组（B组，n=22）。分别比较两组的手术时间、吻合时间、住院时间以及术后并发症发生率，并由手术医师评估吻合的技术难度。结果    57例病人均完成手术，无一例中转开腹。A组总手术时间（251.3±64.4）min，食管空肠吻合时间（37.8±11.6）min，空肠空肠吻合时间（29.4±8.7）min，术后住院（5.5±3.7）d，术后发生吻合相关并发症共2例；B组总手术时间（192.8±52.9）min，食管空肠吻合时间（18.1±7.9）min，空肠空肠吻合时间（14.6±6.3）min，均比A组明显缩短（P＜0.05），术后住院（4.7±4.1）d，少于A组（P＜0.05），术后未发生吻合相关并发症，与A组相比有所下降（2/35 vs. 0/22）。经术者主观评估，B组的吻合技术难度低于A组，经第一助手主观评估，B组的配合难度也低于A组。结论    在机器人全胃切除术中两种吻合方法均安全、可行，免打结自固定缝线法降低了吻合的难度，明显缩短了吻合时间及总手术时间，并能减少病人术后的住院时间。

关键词: 机器人手术系统, 胃癌, 全胃切除术, 消化道重建, 缝线

Abstract:

Comparison of the efficiency between two methods of alimentary tract reconstruction after robot-assisted total gastrectomy for gastric cancer        DIAO Yan-qing, WANG Zhi-ming, JIANG Zhi-wei, et al. Research Institute of General Surgery of PLA, Nanjing General Hospital of Nanjing Military Region, Nanjing 210002, China
Corresponding author：JIANG Zhi-wei, E-mail：surgery34@163.com
Abstract    Objective    To compare the feasibility and difficulty between two methods of alimentary tract reconstruction after robot-assisted total gastrectomy for gastric cancer. Methods    From April 2012 to April 2015，57 patients with gastric cancer in Nanjing General Hospital of Nanjing Military Region were enrolled for robot-assisted total gastrectomy and reconstruction of digestive tract，and all the operations were performed by the same surgeons. In 35 patients (group A)，reconstruction of alimentary canal was performed using single needle running by an absorbable suture. In the other 22 patients (group B), it was performed using two needle running by a barbed suture (180 Polyglyconate Absorbable Knotless Wound Closure Device). Several parameters were evaluated and compared in the two groups, such as time of operation, time of anastomosis, length of hospital stay, and the incidence rate of postoperative complications. In addition，the difficulty of anastomosis was assessed by the surgeon. Results    All the 57 robot-assisted operations were completed successfully without conversion to open surgery. In group A，the total time of surgery was （251.3±64.4）min，time of esophagojejunostomy was （37.8±11.6）min，time of jejunojejunostomy was （29.4±8.7）min，the time of postoperative hospital were （5.5±3.7）days. In group B，the total time of surgery was （192.8±52.9）min，time of esophagojejunostomy was （18.1±7.9）min，time of jejunojejunostomy was （14.6±6.3）min，the time of postoperative hospital were （4.7±4.1） days. Compared with group A，group B represented reduced difficulty in both operation and cooperation，significantly shorter time of the anastomosis， surgery and postoperative hospital stay（P＜0.05）. Furthermore，in group A there were two patients with anastomotic complications (anastomotic stricture)，but in group B they had declined (2/35 vs.0/22). Conclusion    Both two kinds of anastomosis for alimentary canal reconstruction in robotic total gastrectomy are safe and feasible. The use of the barbed suture in totally robotic total gastrectomy would reduce the difficulty of reconstruction of digestive tract and save a lot of time of anastomosis，surgery and postoperative hospital stay.

Key words: robotic surgery, gastric cancer, total gastrectomy, digestive tract reconstruction, barbed suture