Kushibiki Toshihiro, Ebihara Yuma, Hontani Koji, Tanaka Kimitaka, Nakanishi Yoshitsugu, Asano Toshimichi, Noji Takehiro, Kurashima Yo, Murakami Soichi, Nakamura Toru, Tsuchikawa Takahiro, Okamura Keisuke, Shichinohe Toshiaki, Hirano Satoshi
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
Surg Laparosc Endosc Percutan Tech. 2018 Apr;28(2):e49-e53. doi: 10.1097/SLE.0000000000000501.
We have reported the effectiveness of laparoscopy-assisted stomach-partitioning gastrojejunostomy Roux-en-Y reconstruction (LASPGJ-RY) for gastric outlet obstruction (GOO). The aim of this study was to evaluate the surgical outcomes of totally laparoscopic stomach-partitioning gastrojejunostomy Roux-en-Y reconstruction (TLSPGJ-RY) for GOO.
This retrospective study enrolled 19 consecutive patients with GOO. Surgical outcomes of LASPGJ-RY (LA group; n=8) and TLSPGJ-RY (TL group; n=11) between January 2004 and 2015 were compared. The patients' background characteristics, operative findings, postoperative complications, and period to starting postoperative chemotherapy were examined.
Eligible cases included 6 patients with gastric cancer, 4 with pancreatic cancer, 4 with duodenal cancer, 4 with urologic malignancies, and 1 with benign duodenal stenosis. The patients' background characteristics were not significantly different. In surgical outcomes, there were no significant differences in operating time, bleeding, complications (≥Clavien-Dindo grade IIIA), and postoperative hospital stay between the groups. The time to resume diet was significantly shorter in the TL group (median, 3 d; range, 3 to 6 d) than in the LA group (median, 5 d; range, 3 to 7 d; P=0.0093), and the number of patients who could receive chemotherapy after surgery was significantly higher in the TL group (P=0.039).
TLSPGJ-RY was a safe and feasible gastrojejunostomy procedure for GOO. TLSPGJ-RY might be useful for early resumption of oral intake after surgery.
我们已经报道了腹腔镜辅助胃部分切除胃空肠吻合Roux-en-Y重建术（LASPGJ-RY）治疗胃出口梗阻（GOO）的有效性。本研究的目的是评估完全腹腔镜胃部分切除胃空肠吻合Roux-en-Y重建术（TLSPGJ-RY）治疗GOO的手术效果。
这项回顾性研究纳入了19例连续性GOO患者。比较了2004年1月至2015年期间LASPGJ-RY（LA组；n = 8）和TLSPGJ-RY（TL组；n = 11）的手术效果。检查了患者的背景特征、手术发现、术后并发症以及开始术后化疗的时间。
符合条件的病例包括6例胃癌患者、4例胰腺癌患者、4例十二指肠癌患者、4例泌尿系统恶性肿瘤患者和1例良性十二指肠狭窄患者。患者的背景特征无显著差异。在手术效果方面，两组之间的手术时间、出血量、并发症（≥Clavien-Dindo IIIA级）和术后住院时间均无显著差异。TL组恢复饮食的时间（中位数，3天；范围，3至6天）明显短于LA组（中位数，5天；范围，3至7天；P = 0.0093），并且TL组术后能够接受化疗的患者数量明显更多（P = 0.039）。
TLSPGJ-RY是一种治疗GOO安全可行的胃空肠吻合手术。TLSPGJ-RY可能有助于术后早期恢复经口进食。
