CAJ | 학술논문

目的回顾分析完全腹腔镜远端胃大部切除术Delta吻合的安全性和有效性.方法 2011年4月-2014年5月,15例患者因胃癌行完全腹腔镜根治性远端胃大部切除术并采用Delta吻合完成胃十二指肠吻合.统计手术时间、吻合口瘘、吻合口出血、狭窄等并发症;淋巴结清扫数目,病灶和近、远端切缘间距离,随访生存情况.结果 15例手术没有中转开腹病例,平均手术时间(274.9±55.5) min,Delta吻合平均耗时(32.6±4.9) min.没有吻合口瘘,1例患者在术后第10天、辅助化疗第2天上消化道出血,经保守治疗治愈.1例患者术后3个月吻合口狭窄,经保守治疗缓解.平均每例清扫(23.O±7.8)枚淋巴结,无阳性切缘,肿瘤距近、远侧切缘平均距离分别为(5.8±2.6) cm和(3.8±2.1) cm.1、3年累积生存率分别为92％、83％.结论 Delta吻合操作简便、安全可靠,是胃窦部和胃体下部胃癌完全腹腔镜手术可供选择的消化道重建方法.
목적 회고분석완전복강경원단위대부절제술Delta문합적안전성화유효성.방법 2011년4월-2014년5월,15례환자인위암행완전복강경근치성원단위대부절제술병채용Delta문합완성위십이지장문합.통계수술시간、문합구루、문합구출혈、협착등병발증;림파결청소수목,병조화근、원단절연간거리,수방생존정황.결과 15례수술몰유중전개복병례,평균수술시간(274.9±55.5) min,Delta문합평균모시(32.6±4.9) min.몰유문합구루,1례환자재술후제10천、보조화료제2천상소화도출혈,경보수치료치유.1례환자술후3개월문합구협착,경보수치료완해.평균매례청소(23.O±7.8)매림파결,무양성절연,종류거근、원측절연평균거리분별위(5.8±2.6) cm화(3.8±2.1) cm.1、3년루적생존솔분별위92％、83％.결론 Delta문합조작간편、안전가고,시위두부화위체하부위암완전복강경수술가공선택적소화도중건방법.
Objective To evaluate the feasibility of Delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for patients with distal gastric cancer.Methods Fifteen patients with gastric cancer were treated with totally laparoscopic distal gastrectomy,and Delta-shaped gastroduodenostomies were performed for the reconstruction of gastrointestinal continuity.The medical records were reviewed retrospectively,the durations of operation and the Delta-shaped gastroduodenostomy were calculated.Occurrence of severe complications such as anastomosis insufficiency,bleeding and stenosis,the number of lymph nodes were retrievaled,the distances between the margin of gastric cancer and the distal or proximal margins were recorded.The patients were follow upped and the 1 and 3-year cumulated overall survival rate were calculated.Results All the patients were treated with totally laparoscopic gastrectomy,without conversion to open surgery.The average duration of operation was (274.9 ± 55.5) min and the Delta-shaped anastomosis cost about (32.6 ±4.9) min.There was no anastomosis insufficiency occurred.One patient suffered upper gastrointestinal hemorrhage on postoperative day 10 (one day after the initiation of adjuvant chemotherapy).Anastomotic stenosis occurred in one patient three months after operation.Both patients were treated conservatively with an uneventful course.Averagely (23.0 ± 7.8) lymph nodes were tetrievaled for each patient.There was no positive margin,the proximal and distal distance between the focus and the resection line were (5.8 ± 2.6) cm and (3.8 ± 2.1) cm respectively.The cumulated one and 3-year overall survival rates were 92％ and 83％ respectively.Conclusions The Deha-shaped gastroduodenostomy was a safe and effective way for the reconstruction of gastrointestinal continuity in totally laparoscopic distal gastrectomy.