Huang Changming, Lin Mi, Chen Qiyue, Lin Jianxian, Zheng Chaohui, Li Ping, Xie Jianwei, Wang Jiabin, Lu Jun, Chen Tan, Yang Xintao
Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China,
Ann Surg Oncol. 2015 Jan;22(1):247. doi: 10.1245/s10434-014-3862-8. Epub 2014 Jun 27.
The delta-shaped gastroduodenostomy, an intracorporeal Billroth-I anastomosis after laparoscopic distal gastrectomy and using only endoscopic linear staplers, has been increasingly adopted by gastrointestinal surgeons.1 (-) 5 We modified this technique to simplify operation procedures and reduce surgical trauma in patients with gastric cancer.
After the stomach and duodenum were transected in predetermined positions, small incisions were made on the greater curvature of the remnant stomach and the posterior side of the duodenum. The forks of the stapler in each incision were closed and fired following approximation of the posterior walls of the gastric remnant and duodenum. The involution of the common stab incision was accomplished only by the instruments of the surgeon and assistant, and the duodenal cutting edge was completely resected when the common stab incision was closed with the stapler, thus decreasing the anastomotic weak point and avoiding poor blood supply to the duodenal stump. The above procedure was performed for 41 patients with stage cT1-4a disease.
Mean operation time was 143.4 ± 23.4 min, mean anastomosis time was 13.9 ± 2.8 min, mean blood loss was 34.6 ± 20.8 ml, and mean times to first flatus, fluid diet, and soft diet were 3.5 ± 1.3, 5.1 ± 1.2, and 8.1 ± 4.3 days, respectively. No patient experienced any anastomosis-related complications, such as anastomotic leakage, anastomotic stricture, or anastomotic hemorrhage. At a median follow-up of 10 months, no patient had died or experienced recurrent or metastatic disease.
The modified technique was technically safe and feasible, with acceptable surgical outcomes, in patients with gastric cancer.
三角形胃十二指肠吻合术是腹腔镜远端胃切除术后的一种体内毕罗一式吻合术，仅使用内镜直线切割缝合器，已越来越多地被胃肠外科医生采用。1（-）5我们对该技术进行了改良，以简化手术操作程序并减少胃癌患者的手术创伤。
在预定位置切断胃和十二指肠后，在残胃大弯侧和十二指肠后侧做小切口。在残胃和十二指肠后壁靠拢后，将缝合器的钉仓在每个切口中关闭并击发。共同穿刺切口的内卷仅由术者和助手的器械完成，在用缝合器关闭共同穿刺切口时，十二指肠切缘被完全切除，从而减少吻合薄弱点并避免十二指肠残端血供不良。对41例cT1-4a期疾病患者进行了上述手术。
平均手术时间为143.4±23.4分钟，平均吻合时间为13.9±2.8分钟，平均失血量为34.6±20.8毫升，首次排气、流食和软食的平均时间分别为3.5±1.3天、5.1±1.2天和8.1±4.3天。没有患者出现任何与吻合相关的并发症，如吻合口漏、吻合口狭窄或吻合口出血。在中位随访10个月时，没有患者死亡或出现复发或转移性疾病。
改良技术在胃癌患者中技术上安全可行，手术结果可接受。
