Circular stapler versus linear stapler in Billroth Ⅱanastomosis after distal gastric cancer surgery
-
摘要:目的 比较圆形吻合器与直线吻合器在远端胃癌手术毕Ⅱ式吻合术中行消化道重建的效果。方法 选取80例行根治性远端胃大部切除术的胃癌患者，采用随机数表法分为吻合器A组(n=40)与吻合器B组(n=40)。吻合器A组、B组分别采用圆形吻合器与直线吻合器行消化道重建，比较2组手术相关指标、术后胃肠道功能恢复时间、住院情况及并发症发生率。结果 2组患者手术时间、术中出血量、淋巴结清扫数、住院时间、住院费用比较，差异均无统计学意义(P>0.05)。吻合器B组术后首次排气时间、首次进食时间均显著短于吻合器A组(P < 0.05)。2组均未发生吻合口瘘和十二指肠残端瘘, 2组术后吻合口出血、吻合口狭窄、腹腔内感染、胃排空障碍等发生率以及总并发症发生率比较，差异均无统计学意义(P>0.05)。结论 远端胃癌手术毕Ⅱ式吻合术中采用圆形吻合器和直线吻合器行消化道重建均是安全有效的，但直线吻合器在术后胃肠道功能恢复方面更具优势。Abstract:Objective To compare the effect of circular stapler and linear stapler in digestive tract reconstruction by Billroth Ⅱ anastomosis after distal gastric cancer surgery.Methods A total of 80 patients with radical distal subtotal gastrectomy were selected and randomly divided into stapler group A (n=40) and stapler group B (n=40). Circular stapler and linear stapler were used to reconstruct digestive tract in stapler group A and stapler group B respectively. The operation related indexes, recovery time of gastrointestinal function, hospitalization and incidence rate of complications were compared between the two groups.Results There were no significant differences in operation time, intra-operative blood loss, lymph node dissection, hospitalization time and hospitalization expenses between the two groups (P>0.05). The time to first exhaustion and the time to first meal in stapler group B were significantly shorter than those in stapler group A (P < 0.05). There was no anastomotic leakage or duodenal stump fistula in both groups. There were no significant differences in the incidence rates of anastomotic bleeding, anastomotic stenosis, intra-peritoneal infection, gastric emptying disorder and total complications between the two groups (P>0.05).Conclusion Circular stapler and linear stapler are safe and effective in digestive tract reconstruction after distal gastric cancer operation, but linear stapler has more advantages in recovery of gastrointestinal function after operation.
-
-
表 1 2组患者手术相关指标比较(x±s)
组别 n 手术时间/min 术中出血量/mL 淋巴结清扫数/枚 吻合器A组 40 235.70±46.25 162.34±27.80 29.75±2.17 吻合器B组 40 229.98±47.13 159.82±30.42 30.14±2.20 
下载: 导出CSV
表 2 2组术后胃肠功能恢复以及住院情况比较(x±s)
组别 n 首次排气时间/d 术后进流食时间/d 住院时间/d 住院费用/元人民币 吻合器A组 40 4.31±0.92 6.28±1.47 8.63±2.14 34 289.60±7 509.27 吻合器B组 40 3.85±0.75* 5.57±1.32* 8.27±2.05 33 758.49±7 358.41 与吻合器A组比较, *P < 0.05。
下载: 导出CSV
表 3 2组术后相关并发症比较[n(%)]
组别 n 吻合口出血 吻合口狭窄 腹腔内感染 胃排空障碍 总计 吻合器A组 40 2(5.00) 1(2.50) 0 2(5.00) 5(12.50) 吻合器B组 40 1(2.50) 2(5.00) 1(2.50) 0 4(10.00)
下载: 导出CSV
-
[1] 黄昌明, 李子禹, 臧潞.全腹腔镜远端胃癌根治术消化道重建方式选择——Billroth-Ⅰ式、Billroth-Ⅱ式还是Roux-en-Y吻合[J].中国实用外科杂志, 2016, 36(9): 953-954, 957. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201609009.htm [2] 中华医学会外科学分会腹腔镜与内镜外科学组, 中国研究型医院学会机器人与腹腔镜外科专业委员会.腹腔镜胃癌手术操作指南(2016版)[J].中华消化外科杂志, 2016, 15(9): 851-857. doi: 10.3760/cma.j.issn.1673-9752.2016.09.001 [3] 韩方海, 杨斌.解读第15版日本胃癌处理规约[J].中华胃肠外科杂志, 2018, 21(4): 409-412. doi: 10.3760/cma.j.issn.1671-0274.2018.04.010 [4] 牟一平.完全腹腔镜胃癌根治术消化道重建方式的选择及技巧[J].腹腔镜外科杂志, 2012, 17(5): 339-341. doi: 10.3969/j.issn.1009-6612.2012.05.006 [5] 高嘉良, 汪亦民, 马岩.远端胃癌根治术行Billroth Ⅰ和改良Billroth Ⅱ消化道重建后生存质量分析[J].现代肿瘤医学, 2019, 27(5): 102-106. https://www.cnki.com.cn/Article/CJFDTOTAL-SXZL201905025.htm [6] 臧潞, 马君俊.全腹腔镜胃癌根治术消化道重建及相关并发症处理[J].中国实用外科杂志, 2017, 37(4): 369-373. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201704014.htm [7] Kyogoku N, Ebihara Y, Shichinohe T, et al. Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matched study[J]. Langenbeck′s Archives of Surgery, 2018, 403(4): 463-471. doi: 10.1007/s00423-018-1678-x
[8] 冯兴宇, 王伟, 臧潞, 等.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[J].中国实用外科杂志, 2016, 36(12): 1288-1292. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201612010.htm [9] 李捷, 王家兴, 刘召洪, 等.腹腔镜根治性近端胃或全胃切除术中3种不同吻合器钉座置入方法的对比研究[J].中国微创外科杂志, 2017, 17(6): 515-518. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWWK201706011.htm [10] 张楠, 苏向前, 徐凯.直线吻合器与圆形吻合器在毕Ⅱ式吻合术中的应用比较[J].中华胃肠外科杂志, 2018, 21(2): 201-205. doi: 10.3760/cma.j.issn.1671-0274.2018.02.016 [11] Gong C S, Kim B S, Kim H S. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience[J]. World Journal of Gastroenterology, 2017, 23(48): 8553-8561. doi: 10.3748/wjg.v23.i48.8553
[12] 苗儒林, 李子禹, 季加孚.直线吻合器在胃癌腹腔镜手术中的应用[J].中华胃肠外科杂志, 2016, 19(8): 958-960. doi: 10.3760/cma.j.issn.1671-0274.2016.08.036 [13] 李鹏, 李涛, 斯坎德尔·努尔买买提.两种不同全胃切除术治疗对胃上、中癌患者术后发生反流性食管炎的影响[J].中华胃食管反流病电子杂志, 2018, 5(3): 12-14. https://www.cnki.com.cn/Article/CJFDTOTAL-SDFL201803003.htm [14] 邹贵军, 胡时栋, 王迪, 等.全腹腔镜远端胃癌根治术后消化道重建方式的对比[J].腹腔镜外科杂志, 2016, 21(11): 820-823. https://www.cnki.com.cn/Article/CJFDTOTAL-FQJW201611006.htm
计量
- 文章访问数: 374
- HTML全文浏览量: 203
- PDF下载量: 6
苏公网安备 32100302010246号
