中国实用外科杂志

中国实用外科杂志

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全腹腔镜下圆形吻合器与直线切割闭合器行食管空肠吻合疗效对照研究

冯兴宇1，王    伟2，臧    潞3，李子禹4，臧卫东5，朱甲明6，梁    峰7，张    健8，燕    速9，余    江10，武爱文4，季    刚11，樊    林12，尤    俊13，王    宽14，谢    锷15，向    军16，赵    曦17，李    勇1   

  1. 1广东省人民医院普外科 广东省医学科学院，广东广州510080； 2广东省中医院胃肠外科，广东广州510120；3上海交通大学医学院附属瑞金医院外科，上海200025；4北京大学肿瘤医院胃肠外科，北京100142；5福建省肿瘤医院，福建福州350014；6吉林大学第二医院，吉林长春130041；7中国人民解放军307医院普通外科，北京100071；8杭州市第一人民医院胃肠肛外科，浙江杭州310006；9青海大学附属医院胃肠肿瘤外科，青海西宁810001；10南方医科大学南方医院普通外科，广东广州510515；11第四军医大学西京医院胃肠外科，陕西西安710032；12西安交通大学第一附属医院普通外科，陕西西安710061；13 厦门大学附属第一医院肿瘤外科，福建厦门361003；14哈尔滨医科大学附属肿瘤医院胃肠肿瘤外科，黑龙江哈尔滨150000；15汕头市中心医院普外科，广东汕头515031；16 中山大学附属第六医院胃肠外科，广东广州510655；17东莞厚街医院普外科，广东东莞441900
  • 出版日期:2016-12-01 发布日期:2016-12-01

  • Online:2016-12-01 Published:2016-12-01

摘要：

目的    对比圆形吻合器和直线切割闭合器应用于全腹腔镜全胃切除术后消化道重建的安全性和短期疗效。方法　回顾性分析224例全胃切除术后全腹腔镜消化道重建的胃癌病人临床资料，根据消化道重建方式不同分为圆形吻合器吻合组（圆形吻合组）90例，直线切割闭合器吻合组（直线吻合组）134例。结果    直线吻合组在消化道重建时间方面用时更短（47.4 min vs. 52.3 min  P=0.015），两组在出血量、近切缘及重建费用方面差异无统计学意义。两组病人在术后排气时间、进食流质时间、半流饮食时间和术后住院时间方面差异均无统计学意义。两组病人均无围手术期死亡病例，并发症发生率差异亦无统计学意义（11.1% vs. 11.9%，P=0.849）。结论    圆形吻合器和直线切割闭合器应用于全胃术后全腹腔镜下消化道食管空肠重建安全可行，直线切割闭合器方式在消化道重建时间方面具有优势。

关键词: 胃癌, 腹腔镜, 胃切除术, 圆形吻合, 直线吻合

Abstract:

Various types of intracorporealesophagojejunostomy after laparoscopic total gastrectomy for gastric cancer：A national multi-center retrospective study        FENG Xing-yu*,WANG Wei, ZANG Lu, et al. *Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
Corresponding author： LI Yong, E-mail：yuan821007@126.com
Abstract    Objective    To compare the security and short-term effect of the digestive reconstruction during the totally laparoscopic total gastrectomy for gastric cancer between the circular anastomosis and linear anastomosis. Methods    The clinical data of 224 gastric cancer patients with digestive reconstruction underwent totally laparoscopic total gastrectomy between January 2011 and June 2016 in 17 domestic hospitals were analyzed retrospectively.According to the difference of digestive reconstruction，all the patients can be divided into the circularanastomosis with 90 patients and the linear anastomosis with 134 cases.Results The operative time in digestive reconstruction with linear anastomosis was shorter (47.4 min vs. 52.3 min, P＝0.015). There was no difference between the two groups on the intraoperative blood loss，near cutting margin，cost of the reconstruction，postoperative exhaust time，fluid diet，soft diet and the duration of postoperative hospital stay.Both groups had no death case during the perioperative period and there was no significant statistical difference of the postoperative complication rate(11.1% vs.11.9%, P＝0.849). Conclusion    The circular anastomosis and linear anastomosis are both safe and feasible for the digestive reconstruction under the totally laparoscopic total gastrectomy for gastric cancer.Besides，the linear anastomosis has the advatage of the less reconstruction time.

Key words: gastric cancer, laparoscopic surgery, gastrectomy, circular anastomosis, linear anastomosis