CAJ | 학술논문

目的：介绍一种完全腹腔镜下远端胃大部切除后消化道重建的新方法———β形毕Ⅱ式吻合。方法回顾性分析2012年1月至2014年9月间在第三军医大学新桥医院行完全腹腔镜下远端胃大部切除β形毕Ⅱ式吻合（由于胃肠吻合口形似β，初步将其命名为β形毕Ⅱ式吻合）的17例远端胃癌患者的临床资料。远端胃大部分切除后，将近端空肠上提与残胃后壁或大弯侧胃壁行胃空肠吻合，采用腔内直线切割闭合器将残胃与近端空肠通过共同开口行双向侧-侧吻合。结果本组17例患者均顺利完成全腹腔镜下远端胃癌根治切除β形毕Ⅱ式胃肠吻合重建术，无中转开腹或手术死亡病例。手术时间（207．3±11．3） min，其中吻合时间（41．2±2．5） min。术中出血量（160．0±10．0） ml，淋巴结清扫数目（25．5±2．0）枚。术后病理检查无残端残留癌。术后肛门排气时间（2．6±0．2） d，住院时间（10．0±0．4） d。术后随访6～14月，全组患者无吻合口瘘、出血、狭窄及腹腔脓肿、肠梗阻等并发症发生。结论完全腹腔镜下采直线切割闭合器行“β”形毕Ⅱ式吻合安全、可行，能有效避免吻合口狭窄等并发症的发生。
목적：개소일충완전복강경하원단위대부절제후소화도중건적신방법———β형필Ⅱ식문합。방법회고성분석2012년1월지2014년9월간재제삼군의대학신교의원행완전복강경하원단위대부절제β형필Ⅱ식문합（유우위장문합구형사β，초보장기명명위β형필Ⅱ식문합）적17례원단위암환자적림상자료。원단위대부분절제후，장근단공장상제여잔위후벽혹대만측위벽행위공장문합，채용강내직선절할폐합기장잔위여근단공장통과공동개구행쌍향측-측문합。결과본조17례환자균순리완성전복강경하원단위암근치절제β형필Ⅱ식위장문합중건술，무중전개복혹수술사망병례。수술시간（207．3±11．3） min，기중문합시간（41．2±2．5） min。술중출혈량（160．0±10．0） ml，림파결청소수목（25．5±2．0）매。술후병리검사무잔단잔류암。술후항문배기시간（2．6±0．2） d，주원시간（10．0±0．4） d。술후수방6～14월，전조환자무문합구루、출혈、협착급복강농종、장경조등병발증발생。결론완전복강경하채직선절할폐합기행“β”형필Ⅱ식문합안전、가행，능유효피면문합구협착등병발증적발생。
Objective To investigate the feasibility and safety of the new β-shaped intracorporeal Billroth Ⅱ gastrojejunostomy using laparoscopic linear stapler after totally laparoscopic distal gastrectomy. Methods Clinical data of 17 patients with distal gastric cancer who underwentβ-shape intracorporeal Billroth Ⅱ reconstruction after totally laparoscopic distal gastrectomy in our department from January 2012 to September 2014 were analyzed retrospectively. Laparoscopic linear stapler was used in intracorporeal β-shaped BillrothⅡside-to-side gastrojejunostomy for reconstruction. Results All the 17 patients underwent β-shape intracorporeal BillrothⅡ reconstruction after totally laparoscopic distal gastrectomy successfully. There were no conversions and perioperative deaths. The average operative time was (207.3±11.3) min and the average anastomosis time was (41.2±2.5) min. The average number of harvested lymph node was 25.5 ±2.0 and estimated blood loss was (160.0 ± 10.0) ml. The mean number of stapler was 6.5±0.2. The mean time to first flatus was (2.6±0.2) d and the mean hospital stay was (10.0±0.4) d. No anastomotic stenosis, leakage or other complications were found during 6 to 14 month follow-up. Conclusions The β-shaped intracorporeal Billroth Ⅱanastomosis technique after totally laparoscopic distal gastrectomy is safe and feasible. Anastomo tic stenosis can be avoided using this new anastomosis method.