Guzman Eduardo A, Dagis Andy, Bening Lisa, Pigazzi Alessio
City of Hope National Medical Center, Department of General Oncologic Surgery, 1500 East Duarte Road, Duarte, CA 91010, USA.
Am Surg. 2009 Feb;75(2):129-32.
Surgical palliation is an important therapeutic goal in patients with gastric outlet obstruction from cancer. The use of laparoscopic approaches for this condition has not been well studied. Our objective is to compare surgical outcomes of laparoscopic and open gastrojejunostomies in patients with gastric outlet obstruction secondary to advanced malignancies. We did a retrospective review of 20 patients who underwent a palliative gastrojejunostomy as their primary surgical procedure. There were 10 patients in the laparoscopic group and 10 patients in the open one. We identified no significant difference between groups in mean surgery time (116 vs 116 minutes) (P = 0.99), blood loss (23 vs 142 mL) (P = 0.19), or length of stay (8 vs 14 days) (P = 0.14). We also identified no difference in median time to tolerate a regular diet (7 vs 8 days) (P = 0.49) and median survival (11.2 vs 9.0 months) (P = 0.83). Delayed gastric emptying was the most common complication occurring in four patients. There is no detectable difference in surgical outcomes between laparoscopic and open gastrojejunostomies in the management of patients with obstruction of the gastric outlet secondary to cancer. Laparoscopic gastrojejunostomy is a safe and feasible operation in this setting.
手术姑息治疗是胃癌导致胃出口梗阻患者的重要治疗目标。对于这种情况，腹腔镜手术方法的应用尚未得到充分研究。我们的目的是比较腹腔镜胃空肠吻合术和开腹胃空肠吻合术在晚期恶性肿瘤继发胃出口梗阻患者中的手术效果。我们对20例行姑息性胃空肠吻合术作为主要手术的患者进行了回顾性研究。腹腔镜组和开腹组各有10例患者。我们发现两组在平均手术时间（116分钟对116分钟）（P = 0.99）、失血量（23毫升对142毫升）（P = 0.19）或住院时间（8天对14天）（P = 0.14）方面无显著差异。我们还发现两组在耐受正常饮食的中位时间（7天对8天）（P = 0.49）和中位生存期（11.2个月对9.0个月）（P = 0.83）方面也无差异。胃排空延迟是最常见的并发症，有4例患者发生。在癌症继发胃出口梗阻患者的治疗中，腹腔镜胃空肠吻合术和开腹胃空肠吻合术的手术效果无明显差异。在这种情况下，腹腔镜胃空肠吻合术是一种安全可行的手术。
