Yan Chao, Yan Min, Zhu Zhenglun, Liu Wentao, Chen Mingmin, Xiang Ming, Yao Xuexin, Bi Renda, Zhu Zhenggang
Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai Key Laboratory of Stomach Neoplasms, Shanghai 200025, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2014 May;17(5):438-43.
To investigate the feasibility of delta-shaped (DS) gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer.
From July 2013 to November 2013, 22 gastric cancer patients underwent DS gastroduodenostomy using laparoscopic linear stapler. All the patients underwent TLDG with D2 lymphadenectomy. In addition, modified DS anastomosis (when closing the common entry hole, previous duodenal staple line was also removed) was used in selected patients. Clinical data of these 22 patients were retrospectively analyzed.
All the patients underwent TLDG with D2 lymphadenectomy and DS gastroduodenostomy. Among them, 12 patients underwent modified DS anastomosis. The total operative time was (194.6±38.4) min, and the DS anastomosis time was (19.1±14.1) min. The number of linear stapler cartridges used per patient was 5.8±0.8. The intraoperative blood loss was (49.5±24.0) ml. The number of lymph nodes harvested per patient was 32.8±12.4. All the patients achieved microscopic cancer-free resection margin. The time to the first postoperative flatus, first water intake, and semi-liquid diet was (2.9±0.7) d, (4.8±1.1) d, and (6.6±1.2) d, respectively. The duration of postoperative hospital stay was (10.1±2.3) d. The postoperative complication rate was 9.1% (2/22). No patients developed anastomosis-related complications including anastomotic leakage, stenosis, or bleeding.
Delta-shaped gastroduodenostomy is simple, easy, safe, and feasible. It will be an ideal choice for reconstruction after totally laparoscopic distal gastrectomy, and has great value in clinical practice.
探讨三角形（DS）胃十二指肠吻合术在完全腹腔镜下远端胃癌切除术（TLDG）中的可行性。
2013年7月至2013年11月，22例胃癌患者采用腹腔镜直线切割吻合器行DS胃十二指肠吻合术。所有患者均行TLDG联合D2淋巴结清扫术。此外，部分患者采用改良DS吻合术（关闭共同开口时，切除先前的十二指肠钉合线）。对这22例患者的临床资料进行回顾性分析。
所有患者均行TLDG联合D2淋巴结清扫术及DS胃十二指肠吻合术。其中12例患者行改良DS吻合术。总手术时间为（194.6±38.4）分钟，DS吻合时间为（19.1±14.1）分钟。每位患者使用的直线切割吻合器钉仓数量为5.8±0.8个。术中出血量为（49.5±24.0）毫升。每位患者切除的淋巴结数量为32.8±12.4个。所有患者均实现显微镜下切缘无癌。术后首次排气、首次进水及半流质饮食时间分别为（2.9±0.7）天、（4.8±1.1）天和（6.6±1.2）天。术后住院时间为（10.1±2.3）天。术后并发症发生率为9.1%（2/22）。无患者发生包括吻合口漏、狭窄或出血在内的吻合相关并发症。
三角形胃十二指肠吻合术简单、易行、安全且可行。它将是完全腹腔镜下远端胃癌切除术后重建的理想选择，在临床实践中具有重要价值。
