Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
J Gastrointest Surg. 2010 Feb;14(2):289-94. doi: 10.1007/s11605-009-1082-5. Epub 2009 Nov 11.
Since 2003, we have begun to perform gastrojejunostomy by mechanical stapling for Roux-en-Y reconstruction in distal gastrectomy. We performed a retrospective study to compare the short-term outcomes of anastomosis by mechanical stapling and hand suturing.
We evaluated the data of 701 consecutive patients of gastric adenocarcinoma who underwent conventional open distal gastrectomy with Roux-en-Y reconstruction. The data collected included details on the method used for the Roux-en-Y reconstruction, the disease stage, extent of lymph node dissection, performance rate of truncal vagotomy, operation time, operative blood loss, length of hospital stay, and postoperative complications.
The operation time was significantly shorter in the group in which mechanical stapling was used for the anastomosis (MS group) than in the group in which anastomosis was performed by hand suturing (HS group; 241.1 +/- 56.8 vs. 166.4 +/- 48.3 min; p < 0.05). Postoperatively, delayed gastric emptying occurred in 14 (1.9%) patients, including seven (4.2%) from the MS group and seven (1.3%) from the HS group (p = 0.038).
There were no significant disadvantages of employing mechanical stapling for anastomosis, except for the high rate of delayed gastric emptying. More consideration therefore needs to be given to decreasing the frequency of gastric emptying disturbance post surgery using mechanical staples.
自 2003 年以来，我们开始在远端胃切除术后行 Roux-en-Y 重建时使用机械吻合进行胃空肠吻合。我们进行了一项回顾性研究，比较了机械吻合和手工缝合吻合的短期结果。
我们评估了 701 例连续接受常规开放性远端胃切除术和 Roux-en-Y 重建的胃腺癌患者的数据。收集的数据包括 Roux-en-Y 重建方法、疾病分期、淋巴结清扫范围、干迷走神经切断术的执行率、手术时间、手术失血量、住院时间和术后并发症的详细信息。
机械吻合组（MS 组）的手术时间明显短于手工吻合组（HS 组）（241.1 +/- 56.8 比 166.4 +/- 48.3 min；p < 0.05）。术后，有 14 例（1.9%）患者出现胃排空延迟，其中 MS 组 7 例（4.2%），HS 组 7 例（1.3%）（p = 0.038）。
除了胃排空延迟的发生率较高外，使用机械吻合进行吻合没有明显的劣势。因此，需要更多地考虑使用机械吻合来减少术后胃排空障碍的发生频率。
