Kim Beom Su, Yook Jeong Hwan, Choi Youn Baik, Kim Kab Choong, Kim Min Gyu, Kim Tae Hwan, Kawada Hironori, Kim Byung Sik
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Laparoendosc Adv Surg Tech A. 2011 Jun;21(5):387-91. doi: 10.1089/lap.2010.0515. Epub 2011 May 11.
Totally laparoscopic distal gastrectomy (TLDG) has several advantages over laparoscopic-assisted distal gastrectomy (LADG), including a shorter incision, less pain, and earlier recovery. We compared the feasibility and early surgical outcomes of TLDG and LADG in patients with gastric cancer.
Between September 2008 and December 2009, 180 patients with gastric cancer underwent TLDG with intracorporeal gastroduodenostomy using linear staplers; and between January 2006 and December 2009, 268 patients with gastric cancer underwent LADG with extracorporeal gastroduodenostomy using circular staplers. Clinical features and early surgical outcomes were compared between the two groups.
There were no between-group differences in postoperative clinical course and complications. Postoperative pain and the amount of pain killer administered were significantly lower (P<.05 each), and postoperative scars were smaller in the TLDG group.
TLDG with intracorporeal gastroduodenostomy is as safe and feasible as LADG for patients with gastric cancer. Moreover, TLDG is less invasive and more comfortable for patients than LADG.
全腹腔镜远端胃切除术（TLDG）相较于腹腔镜辅助远端胃切除术（LADG）具有多项优势，包括切口更短、疼痛更少以及恢复更早。我们比较了TLDG和LADG在胃癌患者中的可行性及早期手术结果。
2008年9月至2009年12月期间，180例胃癌患者接受了使用线性吻合器进行体内胃十二指肠吻合的TLDG；2006年1月至2009年12月期间，268例胃癌患者接受了使用圆形吻合器进行体外胃十二指肠吻合的LADG。比较两组患者的临床特征及早期手术结果。
两组患者术后临床病程及并发症方面无差异。TLDG组术后疼痛及止痛药物用量显著更低（均P<0.05），且术后瘢痕更小。
对于胃癌患者，采用体内胃十二指肠吻合的TLDG与LADG一样安全可行。此外，与LADG相比，TLDG对患者的侵袭性更小且更舒适。
