中国实用外科杂志

中国实用外科杂志

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全腹腔镜远端胃癌根治术胃空肠非离断式Roux-en-Y吻合51例疗效分析

马君俊，臧    潞，胡伟国，张鲁阳，洪希周，董    峰，冯    波，郑民华   

  1. 上海交通大学医学院附属瑞金医院胃肠外科  上海市微创外科临床医学中心，上海200025
  • 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    探讨全腹腔镜远端胃癌根治术胃空肠非离断式（Uncut）Roux-en-Y吻合的安全性、可行性和短期疗效。方法    回顾性分析2014年9月至2015年12月上海交通大学医学院附属瑞金医院实施的全腹腔镜远端胃癌D2根治术胃空肠Uncut Roux-en-Y吻合51例临床资料，观察手术时间、术中出血量、淋巴结清扫总数、并发症发生率、住院天数和随访结果。结果    全组51例病例均在全腹腔镜下成功完成，无中转开腹，无术中并发症，无手术相关死亡。手术平均时间为170（135～210）min，其中消化道重建时间为27（24～41）min，术中平均失血为60（30～110）mL。术后平均排气时间2（1～3）d，手术后平均住院天数8（7～12）d。术后1例（2.0%）出现吻合口出血，予以保守治疗后好转。无吻合口漏、十二指肠残端瘘和Roux滞留综合征等相关并发症发生。术后短期随访9（5～20）个月。术后每6个月复查胃镜和胃肠道造影，无反流性胃炎，无空肠阻断处再通。结论    全腹腔镜远端胃癌根治术胃空肠Uncut Roux-en-Y吻合安全、可行，且具有全腹腔镜下操作简便，术后近期再通率低，既避免了Billroth-Ⅱ式吻合的反流性胃炎，又避免了Roux-en-Y吻合的Roux滞留综合征，有临床应用价值。

关键词: 腹腔镜, 胃癌, 消化道重建, 非离断式Roux-en-Y吻合

Abstract:

Uncut Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy：A clinical study of 51 cases        MA Jun-jun，ZANG Lu， HU Wei-guo，et al. Department of Gastrointestinal Surgery，Rui-Jin Hospital，Shanghai Jiao-Tong University School of Medicine; Shanghai Minimal Invasive Surgery Center，Shanghai 200025，China
Corresponding author：ZANG Lu，E-mail：zanglu@yeah.net
Abstract    Objective    To investigate the safety, feasibility and short term outcome of totally laparoscopic uncut Roux-en-Y anastomosis in the distal gastrectomy with D2 dissection for gastric cancer. Methods    The clinical data of 51 cases of total laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D2 dissection for gastric cancer from September 2014 to December 2015 in Rui-Jin Hospital，Shanghai Jiao-Tong University School of Medicine were analyzed retrospectively. The operation time, intraoperative bleeding volume, number of lymph nodes resected, incidence of complication, length of hospital stay and follow-up were observed. Results    All of them underwent total laparoscopic uncut Roux-en-Y anastomosis. All the procedures were performed successfully.There were neither conversions to open surgery，nor intraoperative complications in all 51 cases. The median time of the operation was 170 (135-210) min and the median time of anastomosis was 27(24-41) min. The blood loss was 60 (30-110) mL. The time to flatus and length of postoperative hospital stay were 2 (1-3) d and 8(7-12) d，respectively. One anastomotic bleeding occurred which was cured by conservative treatment. No major postoperative complication occurred，such as anastomotic leak，anastomotic stenosis and Roux stasis syndrome. After a short-term follow up [9(5-20)months]，no recanalization or reflux gastritis was encountered by endoscopy. Conclusion    The totally laparoscopic uncut Roux-en-Y anastomosis in distal gastrectomy with lymph node dissection for gastric cancer is safe and feasible，with a very low rate of recanalization and reflux gastritis.

Key words: laparoscopy, gastric cancer, digestive tract reconstruction, Uncut Roux-en-Y anastomosis