Ichikawa Daisuke, Kubota Takeshi, Kikuchi Shojiro, Fujiwara Hitoshi, Nakanishi Masayoshi, Ikoma Hisashi, Okamoto Kazuma, Sakakura Chohei, Ochiai Toshiya, Kokuba Yukihito, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Surg Laparosc Endosc Percutan Tech. 2009 Oct;19(5):e163-6. doi: 10.1097/SLE.0b013e3181b6c867.
Laparoscopy-assisted distal gastrectomy (LADG) has recently been accepted as a preferred surgical procedure for patient with early gastric cancer. The Billroth-I method has been performed widely because of physiologic advantages and technical simplicity.
Since September 2007, we performed standardized LADG for 35 patients with early gastric cancer. Of these 35 patients, 27 patients were reconstructed by Billroth-I anastomosis. Gastroduodenostomy was performed under direct vision for 11 patients (extracorporeal) and remaining 16 patients were anastomosed under laparoscopic vision facilitated by abdominal wall lifting with a right angle retractor (intracorporeal).
The mean duration of the anastomosis procedure was 17 and 20 minutes in extracorporeal and intracorporeal patients, respectively. The abdominal lifting method with a right angle retractor provided a good visual field without reestablishing pneumoperitoneum. The laparoscopic fine view could prevent surrounding fatty tissues and organs from intervening between the anastomosis planes and consequently guided an accurate and safe anastomosis. Neither anastomotic-related nor pancreatic-related complication was observed in this series.
This anastomotic technique should be useful as an easy and safe reconstruction method in LADG and is especially recommendable for less-experienced laparoscopic gastric surgeons.
腹腔镜辅助远端胃癌切除术（LADG）最近已被公认为早期胃癌患者的首选手术方法。由于其生理优势和技术简单，毕罗一式手术已被广泛应用。
自2007年9月以来，我们对35例早期胃癌患者进行了标准化的LADG。在这35例患者中，27例采用毕罗一式吻合重建。11例患者在直视下进行胃十二指肠吻合术（体外），其余16例患者在腹腔镜直视下通过用直角拉钩提起腹壁进行吻合（体内）。
体外和体内患者吻合手术的平均持续时间分别为17分钟和20分钟。用直角拉钩提起腹壁的方法无需重新建立气腹即可提供良好的视野。腹腔镜的清晰视野可防止周围脂肪组织和器官介入吻合平面之间，从而指导准确、安全的吻合。本系列中未观察到与吻合相关或与胰腺相关的并发症。
这种吻合技术作为LADG中一种简单、安全的重建方法应是有用的，尤其推荐给经验较少的腹腔镜胃外科医生。
