Kim Min-Kyoon, Park Joong-Min, Choi Yoo-Shin, Chi Kyong-Choun
Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
J Laparoendosc Adv Surg Tech A. 2012 Apr;22(3):236-41. doi: 10.1089/lap.2011.0330. Epub 2011 Dec 13.
Billroth I gastroduodenostomy using a circular stapler is the most preferred reconstruction method after laparoscopy-assisted distal gastrectomy (LADG). The optimal stapler size for this procedure has not yet been proposed.
Sixty-five patients who underwent LADG and stapled anastomosis with a 25-mm stapler (25-mm group) and a 29-mm stapler (29-mm group) were enrolled in this study. Clinical data and gastroscopic findings at 6 and 12 months after surgery were retrospectively reviewed.
Postoperative complications and postprandial symptoms were similar in both groups. Gastroscopically, food materials remained more frequently in the remnant stomach in the 25-mm group than in the 29-mm group at 6 months after surgery (P=.041). Gastritis and bile reflux were observed more frequently in the 29-mm group than in the 25-mm group (P=.012 and P=.015, respectively). All these differences in the gastroscopic findings between the two groups decreased at 12 months after surgery except for reflux esophagitis, which was observed more frequently in the 29-mm group (P=.002). The length of the incision was smaller in the 25-mm group than in the 29-mm group (4.39 cm versus 4.95 cm, P=.009).
A small-diameter stapler is a risk factor for gastric stasis in the early postoperative period, whereas a large-diameter stapler is a risk factor for gastritis and bile reflux in the early postoperative period and for esophagitis in the late postoperative period. Thus, a small-diameter circular stapler has more advantages over a large-diameter circular stapler. It also enables a reliable anastomosis through a smaller incision and easy handling of the stapler during anastomosis.
使用圆形吻合器的毕罗一式胃十二指肠吻合术是腹腔镜辅助远端胃切除术（LADG）后最常用的重建方法。目前尚未提出该手术的最佳吻合器尺寸。
本研究纳入了65例行LADG并分别使用25毫米吻合器（25毫米组）和29毫米吻合器（29毫米组）进行吻合的患者。回顾性分析了术后6个月和12个月的临床资料及胃镜检查结果。
两组术后并发症和餐后症状相似。在术后6个月时，胃镜检查发现25毫米组残胃内食物残留比29毫米组更常见（P = 0.041）。29毫米组胃炎和胆汁反流的发生率高于25毫米组（分别为P = 0.012和P = 0.015）。除反流性食管炎在29毫米组更常见（P = 0.002）外，两组间胃镜检查结果的所有这些差异在术后12个月时均减小。25毫米组的切口长度小于29毫米组（4.39厘米对4.95厘米，P = 0.009）。
小直径吻合器是术后早期胃潴留的危险因素，而大直径吻合器是术后早期胃炎和胆汁反流以及术后晚期食管炎的危险因素。因此，小直径圆形吻合器比大直径圆形吻合器具有更多优势。它还能通过较小的切口实现可靠的吻合，并且在吻合过程中吻合器操作简便。
