Department of Gastric Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea.
Surg Endosc. 2011 Apr;25(4):1076-82. doi: 10.1007/s00464-010-1319-0. Epub 2010 Sep 11.
To evaluate the effectiveness of totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG), we compared its early surgical outcomes with those of laparoscopy-assisted distal gastrectomy with gastroduodenostomy (LADG).
We retrospectively analyzed early surgical outcomes in 567 patients who underwent laparoscopic gastrectomy for gastric cancer between January 2009 and March 2010. The patients were divided into those with underwent TLDG and those with underwent LADG. Their surgical outcomes were analyzed according to the WHO Asia-Pacific Obesity classification.
In overall patients, TLDG showed the significant results of early surgical outcomes. But more importantly, in the analysis of early surgical outcomes for obese patients, we found that TLDG could improve overall complication rate (p = 0.031), time to first flatus (p = 0.009), time to commencement of soft diet (p < 0.001), administration of analgesics (p = 0.019), pain score (Numeric Rating Scale, NRS), and hospital discharge (p = 0.003).
We suggested that TLDG contributes to the improvement of early surgical outcomes. We further suggest that TLDG in obese patients could be the best way to improve early surgical outcomes, including the bowel movement, pain score, overall complication rate, and hospital discharge.
评估全腹腔镜胃十二指肠吻合术（TLDG）治疗远端胃癌的有效性，我们将其与腹腔镜辅助胃十二指肠吻合术（LADG）的早期手术结果进行了比较。
我们回顾性分析了 2009 年 1 月至 2010 年 3 月期间接受腹腔镜胃癌手术的 567 例患者的早期手术结果。根据世界卫生组织亚太肥胖分类，将患者分为接受 TLDG 和接受 LADG 的患者。分析他们的手术结果。
在所有患者中，TLDG 显示出早期手术结果的显著效果。但更重要的是，在肥胖患者的早期手术结果分析中，我们发现 TLDG 可以降低整体并发症发生率（p = 0.031）、首次排气时间（p = 0.009）、开始软食时间（p < 0.001）、镇痛药使用时间（p = 0.019）、疼痛评分（数字评分量表，NRS）和出院时间（p = 0.003）。
我们认为 TLDG 有助于改善早期手术结果。我们进一步认为，TLDG 治疗肥胖患者可能是改善早期手术结果的最佳方法，包括肠道运动、疼痛评分、整体并发症发生率和出院时间。
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