Lee Junhyun, Kim Dongjin, Kim Wook
Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea.
J Korean Surg Soc. 2012 Mar;82(3):135-42. doi: 10.4174/jkss.2012.82.3.135. Epub 2012 Feb 27.
In laparoscopic distal gastrectomy for gastric cancer, most surgeons prefer extra-corporeal anastomosis because of technical challenges and unfamiliarity with intra-corporeal anastomosis. Herein, we report the feasibility and safety of intra-corporeal Billroth-II anastomosis in gastric cancer.
From April 2004 to March 2011, 130 underwent totally laparoscopic distal gastrectomy with intra-corporeal Billroth-II reconstruction, and 269 patients underwent laparoscopy-assisted distal gastrectomy with extra-corporeal Billroth-II reconstruction. Surgical efficacies and outcomes between two groups were compared.
There were no differences in demographics and clinicopathological characteristics. The mean operation and reconstruction times of totally laparoscopic distal gastrectomy were statistically shorter than laparoscopy-assisted distal gastrectomy (P = 0.019; P < 0.001). Anastomosis-related complications were observed in 11 (8.5%) totally laparoscopic distal gastrectomy and 21 (7.8%) laparoscopy-assisted distal gastrectomy patients, and the incidence of these events was not significantly different. Post-operative hospital stays for totally laparoscopic distal gastrectomy were shorter than laparoscopy-assisted distal gastrectomy patients (8.3 ± 3.2 days vs. 9.9 ± 5.3 days, respectively; P = 0.016), and the number of times parenteral analgesic administration was required in laparoscopy-assisted distal gastrectomy patients was more frequent after surgery.
Intra-corporeal Billroth-II anastomosis is a feasible procedure and can be safely performed with the proper experience for laparoscopic distal gastrectomy. This method may be less time consuming and may produce a more cosmetic result.
在腹腔镜远端胃癌根治术中，由于技术挑战以及对体内吻合不熟悉，大多数外科医生更倾向于体外吻合。在此，我们报告胃癌体内毕罗Ⅱ式吻合的可行性和安全性。
从2004年4月至2011年3月，130例患者接受了完全腹腔镜远端胃癌根治术并进行体内毕罗Ⅱ式重建，269例患者接受了腹腔镜辅助远端胃癌根治术并进行体外毕罗Ⅱ式重建。比较两组的手术疗效和结果。
两组在人口统计学和临床病理特征方面无差异。完全腹腔镜远端胃癌根治术的平均手术时间和重建时间在统计学上短于腹腔镜辅助远端胃癌根治术（P = 0.019；P < 0.001）。11例（8.5%）完全腹腔镜远端胃癌根治术患者和21例（7.8%）腹腔镜辅助远端胃癌根治术患者观察到吻合相关并发症，这些事件的发生率无显著差异。完全腹腔镜远端胃癌根治术患者的术后住院时间短于腹腔镜辅助远端胃癌根治术患者（分别为8.3±3.2天和9.9±5.3天；P = 0.016），腹腔镜辅助远端胃癌根治术患者术后需要胃肠外镇痛给药的次数更频繁。
体内毕罗Ⅱ式吻合是一种可行的手术方法，对于腹腔镜远端胃癌根治术，有适当经验时可安全实施。该方法可能耗时更少，且可能产生更美观的效果。
