Patel A G, McFadden D W, Hines O J, Reber H A, Ashley S W
Departments of Surgery, Sepulveda VAMC, and UCLA School of Medicine, 10833 Leconte Avenue, Los Angeles, CA, USA 90024-6904, USA.
Surg Endosc. 1996 Jun;10(6):639-43. doi: 10.1007/s004649900118.
Although laparoscopy reveals undetected metastases in many patients with pancreatic cancer, most surgeons have chosen to proceed directly with laparotomy in an attempt at resection or for palliation of biliary and gastric outlet obstruction. In an effort to overcome this limitation, this study attempted to determine the feasibility of laparoscopic cholecystojejunostomy and gastrojejunostomy.
Under general anesthesia, seven pigs underwent laparoscopic cholecystojejunostomy and gastrojejunostomy using either a hand-sutured or the stapled/sutured technique.
Mean operating time was less with the stapled/sutured vs hand-sutured technique (150 +/- 21 vs 230 +/- 13 min, P < 0.05). All animals recovered completely and there was no change in their weight or liver function tests as a result of the procedure. At sacrifice, all anastomoses were patent, although some were significantly narrowed in these unobstructed animals.
These results suggest that simultaneous laparoscopic palliation of biliary and gastric outlet obstruction is feasible. We believe these results warrant further study in the clinical setting.
尽管腹腔镜检查可发现许多胰腺癌患者未被检测到的转移灶，但大多数外科医生选择直接进行剖腹手术，试图进行切除或缓解胆管和胃出口梗阻。为了克服这一局限性，本研究试图确定腹腔镜胆囊空肠吻合术和胃空肠吻合术的可行性。
在全身麻醉下，七头猪采用手工缝合或吻合器/缝合技术进行腹腔镜胆囊空肠吻合术和胃空肠吻合术。
吻合器/缝合技术的平均手术时间比手工缝合技术短（150±21分钟对230±13分钟，P<0.05）。所有动物均完全康复，手术对其体重或肝功能检查无影响。处死时，所有吻合口均通畅，尽管在这些无梗阻的动物中，有些吻合口明显变窄。
这些结果表明，同时进行腹腔镜胆管和胃出口梗阻缓解术是可行的。我们认为这些结果值得在临床环境中进一步研究。
