CAJ | 학술논문

目的研究缝合重建完全腹腔镜下胃癌根治术与腹腔镜辅助下胃癌根治术的优缺点,探讨在完全腹腔镜下缝合重建吻合方式的安全性与可行性.方法回顾性分析2009年7月至2010年7月在第四军医大学西京消化病医院完全腹腔镜下缝合重建胃癌D2根治术与腹腔镜辅助胃癌D2根治术49例患者的临床资料,手术均由同一位经验丰富的普通外科医师完成.结果完全腹腔镜胃癌根治21例中行远端胃切除15例,全胃切除6例,均采用镜下手工缝合胃肠吻合和空肠-空肠吻合,应用25mm管型吻合器完成食管空肠吻合;腹腔镜辅助胃癌根治28例中行远端胃切除21例,全胃切除7例.完全腹腔镜组与腹腔镜辅助组平均手术时间分别为(279±65)min、(232±40)min(P＜0.05),平均肿瘤下切缘为(3.1±0.9)cm、(2.9±0.9)cm(P＞0.05),平均上切缘为(5.7±1.5)cm、(5.1±1.4)cm(P＞0.05),两组切缘均无癌残留.完全腹腔镜组术后无需用镇痛药,腹腔镜辅助组平均使用镇痛药1.8 d;完全腹腔镜组术后通气时间为3 d,腹腔镜辅助组为4.8 d;完全腹腔镜组术后发生早期并发症2例,其中1例腹腔感染,1例肺部感染.腹腔镜辅助组2例,其中1例切口感染,1例肺部感染.术后中位随访时间4个月,两组均无吻合口瘘与狭窄发生.结论完全腹腔镜下缝合重建的胃癌D2根治术具有可以接受的手术时间和早期并发症的发生率,可在有选择的患者中由经验丰富的外科医师应用.
목적 연구봉합중건완전복강경하위암근치술여복강경보조하위암근치술적우결점,탐토재완전복강경하봉합중건문합방식적안전성여가행성.방법 회고성분석2009년7월지2010년7월재제사군의대학서경소화병의원완전복강경하봉합중건위암D2근치술여복강경보조위암D2근치술49례환자적림상자료,수술균유동일위경험봉부적보통외과의사완성.결과 완전복강경위암근치21례중행원단위절제15례,전위절제6례,균채용경하수공봉합위장문합화공장-공장문합,응용25mm관형문합기완성식관공장문합;복강경보조위암근치28례중행원단위절제21례,전위절제7례.완전복강경조여복강경보조조평균수술시간분별위(279±65)min、(232±40)min(P＜0.05),평균종류하절연위(3.1±0.9)cm、(2.9±0.9)cm(P＞0.05),평균상절연위(5.7±1.5)cm、(5.1±1.4)cm(P＞0.05),량조절연균무암잔류.완전복강경조술후무수용진통약,복강경보조조평균사용진통약1.8 d;완전복강경조술후통기시간위3 d,복강경보조조위4.8 d;완전복강경조술후발생조기병발증2례,기중1례복강감염,1례폐부감염.복강경보조조2례,기중1례절구감염,1례폐부감염.술후중위수방시간4개월,량조균무문합구루여협착발생.결론 완전복강경하봉합중건적위암D2근치술구유가이접수적수술시간화조기병발증적발생솔,가재유선택적환자중유경험봉부적외과의사응용.
Objectives To compare total laparoscopic gastrectomy with intracorporeal hand-sewn Gl reconstruction and laparoscopy-assisted gastrectomy for gastric cancer. Methods Between July 2009 and July 2010, 21 patients of gastric cancer underwent total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn reconstruction and 28 did laparoscopy-assisted D2 radical gastrectomy in Xijing Hospital of Digestive Diseases. All patients were operated on by an experienced surgeon. Patient demographics, TNM stage, location of tumor, the intraoperative and postoperative details of the two groups were compared. Results In the 21 patients undergoing total laparoscopic gastrectomy, there were 15 of distal gastrectomy and 6 of total gastrectomy, compared with 21 and 7 in laparoscopy-assisted group. In total laparoscopic group, intracorporeal hand-sewn technique was used for gastro-jejunal and jejuno-jejunal (J-J)anastomosis, and 25 mm circular stapler was used for esophago-jejunal anastomosis. The operation time was significant longer in total laparoscopic group than in laparoscopy-assisted group of (279 ± 65 ) min vs.(232 ±40) min (P ＜ 0.05 ). No significant difference was observed between the two groups in proximal margin [(5.7 ± 1.5 )cm vs. (5.1 ± 1.4) cm, P ＞ 0.05] and distal margin [( 3.1 ± 0.9 )cm vs. ( 2.9 ±0.9) cm,P ＞0.05]. The iv narcotic use in laparoscopy-assisted group was 1.8 d but it was not used in total laparoscopic group. The first passing flatus was on day 3 in total laparoscopic group compared with 4.8 d in laparoscopy-assisted group. Both groups had 2 postoperative early complications, one intra-abdominal infection and one lung infection in total laparoscopic group compared with one wound infection and one lung infection in laparoscopy-assisted group. There was no anastomosis-related complications after 4 months of follow-up. Conclusions The operation time and postoperative early complication was acceptable for selected patients treated by total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn GI tract reconstruction in hands of experienced laparoscopic surgeon.