摘要
目的:探讨在完全腹腔镜下远端胃癌根治术消化道重建中使用倒刺线关闭共同开口及吻合口加针的安全性及效果。方法:回顾分析郑州大学附属肿瘤医院普外科2019年10月至2021年7月由同一手术团队完成的全腹腔镜下远端胃癌根治术62例的资料。使用倒刺线关闭共同开口及吻合口、闭合线加针共32例(观察组),使用直线切割闭合器关闭共同开口及吻合口、闭合线不加针共30例(对照组)。比较两组的一般资料和手术相关指标。结果:两组均顺利完成手术,无中转开腹及术中并发症。两组术前分期、术前血红蛋白含量、术中出血量、术后排气时间、术后住院时间差异均无统计学意义(P>0.05)。观察组、对照组消化道重建时间分别为(39.5±5.1)、(25.8±3.7) min,术前与术后24 h血红蛋白含量差值分别为(11.1±6.2)、(15.6±7.9) g/L,差异均有统计学意义(P<0.05)。两组术后并发症总发生率差异无统计学意义(P>0.05);但观察组无术后出血及吻合口瘘发生,对照组有2例术后消化道出血需内镜下止血,1例胃闭合线与小弯交界处吻合口瘘,对症治疗后好转。结论:使用倒刺线关闭共同开口及吻合口加针虽延长了手术时间,但减轻了吻合口渗血,提高了手术安全性。
Aim:To explore the safety and effectiveness of using barbed suture to close the common opening and oversew the anastomosis and staple line in gastrointestinal reconstruction during total laparoscopic radical gastrectomy.Methods:The clinical data of 62 patients with total laparoscopic radical gastrectomy completed by the same surgical team from October 2019 to July 2021 in the Department of General Surgery of the Affiliated Tumor Hospital of Zhengzhou University were retrospectively analyzed.Among them,32 cases received barbed suture to close the common opening and the anastomotic stoma with oversewing(observation group),30 cases received a linear cutting closure device to close the common opening and the anastomotic stoma without oversewing(control group).The general data,the indexes related with the operaion of the 2 groups were compared.Results:The operation was successfully completed in both groups without conversion to laparotomy and intraoperative complications.There was no significant differences in preoperative staging,preoperative hemoglobin,intraoperative blood loss,postoperative exhaust time,and postoperative hospital stay between the 2 groups(P>0.05).The time of digestive tract reconstruction was(39.5±5.1) and(25.8±3.7) min,and the hemoglobin difference before and after the operation was(11.1±6.2) and(15.6±7.9) g/L in the observation group and the control group,respectively,and the differences were significant(P0.05);but there were no postoperative bleeding and anastomotic fistula patients in the observation group,2 cases of postoperative gastrointestinal bleeding requiring endoscopic hemostasis and 1 case of anastomotic leakage at the junction of gastric closure line and small bend,which improved after symptomatic treatment in the control group.Conclusion:Using barbed suture to close the common opening and the anastomotic stoma with oversewing may prolong the operation time,but reduce anastomotic bleeding,thus improve the safety of operation.
作者
杜记涛
万相斌
付强
赵卫杰
陈广龙
赵智力
张辉亮
曹建
李智
DU Jitao;WAN Xiangbin;FU Qiang;ZHAO Weijie;CHEN Guanglong;ZHAO Zhili;ZHANG Huiliang;CAO Jian;LI Zhi(Department of General Surgery,the Affiliated Tumor Hospital,Zhengzhou University(Henan Cancer Hospital),Zhengzhou 450008)
出处
《郑州大学学报（医学版）》
CAS
北大核心
2022年第6期845-849,共5页
Journal of Zhengzhou University(Medical Sciences)
基金
河南省医学科技攻关计划省部共建项目(SB20191104)。
关键词
胃癌
远端胃癌根治术
全腹腔镜手术
消化道重建
倒刺线
gastric cancer
radical gastrectomy of distal gastric cancer
total laparoscopic surgery
digestive tract reconstruction
barbed suture
