CAJ | 학술논문

目的：探讨胃十二指肠三角吻合术应用于胃癌全腹腔镜下远端胃切除术的可行性。方法2013年7-11月间，上海交通大学医学院附属瑞金医院普通外科对22例胃癌患者应用直线形吻合器进行胃十二指肠三角吻合，完成全腹腔镜下远端胃切除术并D2淋巴结清扫，其中12例应用改良三角吻合术（闭合共同开口时将原十二指肠吻合线一并移去的术式），回顾性总结分析其临床资料。结果22例胃癌患者均于全腹腔镜下完成远端胃切除及胃十二指肠三角吻合，总手术时间（194．6±38．4） min，胃十二指肠三角吻合时间（19．1±14．1） min。术中应用直线形吻合器钉匣（5．8±0．8）个／例。术中出血量（49．5±24．0） ml，淋巴结清扫数目（32．8±12．4）枚／例，上、下切缘病理检查均未见癌残留。术后患者首次肛门排气时间（2．9±0．7） d，恢复饮水时间（4．8±1．1） d，进食半流质时间（6．6±1．2） d，术后住院时间（10．1±2．3） d。全组术后并发症发生率为9．1％（2／22），但均未出现吻合口瘘、梗阻和出血等吻合口相关并发症。结论胃十二指肠三角吻合术简易、安全、可行，是胃癌全腹腔镜下远端胃切除术消化道重建较为理想的术式。
목적：탐토위십이지장삼각문합술응용우위암전복강경하원단위절제술적가행성。방법2013년7-11월간，상해교통대학의학원부속서금의원보통외과대22례위암환자응용직선형문합기진행위십이지장삼각문합，완성전복강경하원단위절제술병D2림파결청소，기중12례응용개량삼각문합술（폐합공동개구시장원십이지장문합선일병이거적술식），회고성총결분석기림상자료。결과22례위암환자균우전복강경하완성원단위절제급위십이지장삼각문합，총수술시간（194．6±38．4） min，위십이지장삼각문합시간（19．1±14．1） min。술중응용직선형문합기정갑（5．8±0．8）개／례。술중출혈량（49．5±24．0） ml，림파결청소수목（32．8±12．4）매／례，상、하절연병리검사균미견암잔류。술후환자수차항문배기시간（2．9±0．7） d，회복음수시간（4．8±1．1） d，진식반류질시간（6．6±1．2） d，술후주원시간（10．1±2．3） d。전조술후병발증발생솔위9．1％（2／22），단균미출현문합구루、경조화출혈등문합구상관병발증。결론위십이지장삼각문합술간역、안전、가행，시위암전복강경하원단위절제술소화도중건교위이상적술식。
Objective To investigate the feasibility of delta-shaped (DS) gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. Methods From July 2013 to November 2013, 22 gastric cancer patients underwent DS gastroduodenostomy using laparoscopic linear stapler. All the patients underwent TLDG with D2 lymphadenectomy. In addition, modified DS anastomosis (when closing the common entry hole, previous duodenal staple line was also removed) was used in selected patients. Clinical data of these 22 patients were retrospectively analyzed. Results All the patients underwent TLDG with D2 lymphadenectomy and DS gastroduodenostomy. Among them , 12 patients underwent modified DS anastomosis. The total operative time was (194.6 ±38.4) min, and the DS anastomosis time was (19.1±14.1) min. The number of linear stapler cartridges used per patient was 5.8± 0.8. The intraoperative blood loss was (49.5 ±24.0) ml. The number of lymph nodes harvested per patient was 32.8±12.4. All the patients achieved microscopic cancer-free resection margin. The time to the first postoperative flatus, first water intake, and semi-liquid diet was (2.9±0.7) d, (4.8±1.1) d, and (6.6±1.2) d, respectively. The duration of postoperative hospital stay was (10.1±2.3) d. The postoperative complication rate was 9.1%(2/22). No patients developed anastomosis-related complications including anastomotic leakage , stenosis, or bleeding. Conclusions Delta-shaped gastroduodenostomy is simple , easy, safe, and feasible. It will be an ideal choice for reconstruction after totally laparoscopic distal gastrectomy, and has great value in clinical practice.