摘要
目的:比较远端胃癌根治术毕Ⅱ式吻合应用圆形吻合器与直线吻合器实施消化道重建的近期安全性、有效性及术后生存质量。方法:回顾性分析2013年1月至2017年7月北京大学肿瘤医院胃肠肿瘤中心四病区行根治性远端胃大部切除术的132例胃腺癌患者的临床资料。根据消化道重建采用吻合器形状的不同,分为圆形吻合器组64例(48.5%)和直线吻合器组68例(51.5%)。比较两组患者术中情况、术后恢复情况、并发症发生率以及术后1年残胃情况。结果:两组手术时间、手术方式、术中出血量、淋巴结清扫数目以及阳性淋巴结数目的差异均无统计学意义(均P>0.05)。直线吻合器组患者较圆形吻合器组患者术后首次排气时间(中位数:3.0 d vs.4.0 d)、首次进食时间(中位数:7.0 d vs.8.0 d)、首次拔除腹腔引流管时间(中位数:7.0 d vs.9.0 d)及术后住院时间(中位数:8.0 d vs.10.0 d)均较短,差异具有统计学意义(均P<0.05);两组患者术后并发症发生率分别为10.9%和1.5%,差异无统计学意义(P=0.056)。术后1年胃镜检查结果显示,两组患者的食物潴留、残胃黏膜炎及胆汁反流发生率,差异均无统计学意义(P>0.05)。结论:在远端胃癌根治术毕Ⅱ式吻合中,直线吻合器组患者术后胃肠道功能恢复更快,患者住院时间更短,更具优势。
Objective：To evaluate the short-term efficacy and the long-term quality of life after surgery using different mechanical staplers in Billroth II reconstruction after distal gastrectomy for gastric cancer. Methods：The clinical data of patients with gastric adenocarcinoma who received distal gastrectomies with Billroth Ⅱ reconstruction in the Department of Gastrointestinal Surgery Ward Ⅳ of Peking University Cancer Hospital, from January 2013 to July 2017, were collected retrospectively. A total of 132 patients were enrolled in the study, with 64 patients in the CS（circular stapler） group and 68 patients in the LS（linear stapler） group. The clinicopathologic characteristics, operative features, postoperative recovery, complication rate, and endoscopy scan for remnant stomach at 1 year after operation were compared between these two groups. Results：There was no significant difference between the two groups in operation time, operation approach, intraoperative bleeding, number of lymph node dissections, and number of positive lymph nodes（all P0.05）. On postoperative recovery, the first flatus time（3.0 days vs. 4.0 days）, first liquid diet time（7.0 days vs. 8.0 days）, first abdominal drainage tube removing time（7.0 days vs. 9.0 days）, and postoperative hospital stay（8.0 days vs. 10.0 days） were shorter in the LS group than in the CS group（all P0.05）. The rates of postoperative complications were 10.9% and 1.5% in the CS and LS groups,respectively（P=0.056）, withnot significant difference. The endoscopies revealed that there were no significant differences in residual food, gastritis, and bile reflux at 12 months postoperatively. Conclusions：For distal gastrectomies with Billroth Ⅱ reconstruction, gastrointestinal function recovery was faster and postoperative hospital stay was shorter in the LS group than in the CS group.
作者
张楠
徐凯
苏向前
Nan Zhang;Kai Xu;Xiangqian Su(Department of Gastrointestinal Surgery Ward Ⅳ,Peking University Cancer Hospital ＆ Institute,Key Laboratory of Carcinogenesis and Translational Research（Ministry of Education）,Beijing 100142,China)
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2018年第14期726-730,共5页
Chinese Journal of Clinical Oncology
基金
国家自然科学基金项目(编号:81672439)
北京市自然科学基金项目(编号:7162039)
首都卫生发展科研专项(编号:首发2018-2-2153)资助~~
关键词
胃肿瘤
远端胃大部切除
机械吻合
圆形吻合器
直线吻合器
gastric neoplasms
distal gastrectomy
mechanical anastomosis
circular stapler
linear stapler
