全腹腔镜远端胃癌三角吻合术与腹腔镜辅助远端胃癌BillrothⅠ吻合术的对比研究

摘要

Objective To compare the clinical efficacy of Delta-shaped anastomosis and Billroth Ⅰ anastomosis of laparoscopic distal gastrectomy for gastric cancer.Methods The clinical data of 135 cases of gastric cancer which received laparoscopic distal gastrectomy from Feb.2014 to Feb.2016 were reviewed.Observation group (n=65) received Delta-shaped anastomosis and control group (n=70) received Billroth Ⅰ anastomosis.Results There was no significant difference in basic characteristics such as age and sex.The operation time in the observation group and control group was 243.5 min and 180.2 min respectively (P=0.005);Time for taking liquid food in the observation group was 52.4±7.5 h,and 45.8±5.3 h in the control group (P=0.042);The proximal distance to tumor edge in the observation group was 48.2±7.5 mm,and 40.4±5.64 mm in the control group (P=0.034);The distal distance to tumor edge in the observation group was 68.5±6.95 mm,and 56.2±6.5 mm in the control group (P=0.028);The number of harvested lymph nodes in the observation group was 34.8±8.4,and 22.2±7.9 in the control group (P=0.04);The blood loss in the observation group was 45.9±10.9 mL,and 80.4±16.3 mL in the control group (P=0.018);The hospital stay in the observation group was 7.4±2.4 d,and 10.4±1.7 d in the control group (P=0.016).There was no significant difference in postoperative complications between two groups.Conclusions Delta-shaped anastomosis of laparoscopic distal gastrectomy is feasible and safe with minimal trauma,quick recovery and good short-term clinical efficacy.%目的 比较全腹腔镜远端胃癌D2根治三角吻合术与腹腔镜辅助远端胃癌D2根治BillrothⅠ吻合术的临床疗效.方法 回顾性分析2014年2月至2016年2月间解放军总医院普通外科行远端胃癌D2根治临床病人135例的临床资料.观察组65例,行全腹腔镜远端胃癌D2根治三角吻合术;对照组70例,行腹腔镜辅助远端胃癌D2根治BillrothⅠ吻合术.结果 两组病人性别及年龄等基本资料差异无统计学意义.观察组手术时间 243.5 min,对照组 180.2 min(P=0.005);观察组进食流质食物时间为(52.4±7.5) h,对照组为(45.8±5.3) h(P=0.042);观察组近端距离肿瘤为(48.2±7.5) mm,对照组为(40.4±5.6) mm(P=0.034);观察组远端距离肿瘤为(68.5±6.95) mm,对照组为(56.2±6.5) mm(P=0.028);观察组淋巴结清扫数为(34.8±8.4)个,对照组为(22.2±7.9)个(P=0.04);观察组手术出血量为(45.9±10.9) ml,对照组为(80.4±16.3) ml(P=0.018);观察组住院时间为(7.4±2.4) d,对照组为(10.4±1.7) d(P=0.016).两组间术后并发症发生率差异无统计学意义.结论 全腹腔镜下远端胃癌根治三角吻合技术具有创伤小、术后恢复快等优点,近期临床效果明显.