Jian-Cheng Tu, Bo Zhang, Jian Fang, Liang Zhou
From the Department of General Surgery, Zhangjiagang Hospital Affiliated to Soochow University, Jiangsu Province, P.R. China (TJ-C, ZB, FJ, ZL).
Medicine (Baltimore). 2015 Jul;94(28):e1153. doi: 10.1097/MD.0000000000001153.
This study aims to explore the technical feasibility, safety, and clinical efficacy of delta-shaped anastomosis for digestive tract reconstruction during totally laparoscopic distal gastrectomy. Clinical data of 24 patients who received totally laparoscopic distal gastrectomy with delta-shaped anastomosis (laparoscopic gastrectomy group, LG group) and 30 patients who received open distal gastrectomy for gastric cancer (open gastrectomy group, OG group) from April 2013 to April 2014 were retrospectively analyzed. Operation time, intraoperative blood loss, postoperative time to intestinal function recovery, postoperative pain, postoperative hospital stay, and incidence of postoperative complications (infection, obstruction, and delayed gastric emptying) were compared between these 2 groups. Patients in both groups were discharged without marked complications. No patients who initially selected laparoscopy were converted to laparotomy. Patients in the LG group had longer operation times (175.3 ± 64.7 minutes versus 120.1 ± 43.4 minutes, P < 0.05), lower intraoperative blood loss (50.8 ± 25.3 mL versus 95.6 ± 20.7 mL, P < 0.05), faster recovery of intestinal function (1.2 ± 0.5 days versus 2.6 ± 1.0 days, P < 0.05), less postoperative pain (5.6 ± 0.7 versus 9.5 ± 0.3, P < 0.05), and shorter length of postoperative hospital stay (8.5 ± 2.2 days versus 12.2 ± 3.8 days, P < 0.05), compared with patients in the OG group. There were no significant differences with respect to surgical margins achieved, the number of lymph nodes retrieved or incidence of postoperative complications (infection, obstruction, and delayed gastric emptying) between the 2 groups (P > 0.05). Laparoscopic reconstruction of the digestive tract through delta-shaped anastomosis appears to be safe, feasible, and associated to rapid recovery. These data argue for more wide-spread implementation of this procedure.
本研究旨在探讨完全腹腔镜下远端胃切除术中采用三角形吻合术进行消化道重建的技术可行性、安全性及临床疗效。回顾性分析了2013年4月至2014年4月期间接受完全腹腔镜下远端胃切除术并采用三角形吻合术的24例患者（腹腔镜胃切除术组，LG组）及30例行开放性远端胃癌切除术的患者（开放性胃切除术组，OG组）的临床资料。比较了两组患者的手术时间、术中出血量、术后肠功能恢复时间、术后疼痛程度、术后住院时间及术后并发症（感染、梗阻及胃排空延迟）发生率。两组患者均无明显并发症出院。最初选择腹腔镜手术的患者均未中转开腹。与OG组患者相比，LG组患者手术时间更长（175.3±64.7分钟 vs 120.1±43.4分钟，P<0.05），术中出血量更少（50.8±25.3 mL vs 95.6±20.7 mL，P<0.05），肠功能恢复更快（1.2±0.5天 vs 2.6±1.0天，P<0.05），术后疼痛更轻（5.6±0.7 vs 9.5±0.3，P<0.05），术后住院时间更短（8.5±2.2天 vs 12.2±3.8天，P<0.05）。两组患者在切缘、清扫淋巴结数量及术后并发症（感染、梗阻及胃排空延迟）发生率方面差异无统计学意义（P>0.05）。通过三角形吻合术进行腹腔镜消化道重建似乎是安全、可行的，且与快速康复相关。这些数据支持更广泛地应用该手术方法。
