改良三角吻合在腹腔镜远端胃癌根治术中的应用

摘要

Objective To investigate the short term effect of the modified delta-shaped gastroduodenostomy (Mod-DSG) in totally laparoscopic distal gastrectomy(TLDG) of gastric cancer. Methods Sixty-seven cases of gastric cancer treated by TLDG in the gastrointestinal surgery department of the Second Affiliated Hospital of Chongqing Medical University from February 2014 to February 2016 were selected,including 35 cases of conventional DSG(Con-DSG) and 32 cases of Mod-DSG. The clinicopathologi-cal characteristics such as lymph nodes clearing,postoperative hospital stay,anastomosis size,anastomosis time,postoperative complications and non-plan reoperation were retrospectively analyzed and compared between the two groups. Results No statis-tically significant differences between the two groups were found in the anastomosis diameter[ (28.7±3.1)mm vs. (29.9±3.1)mm], digestive tract reconstruction time[(19.0±3.1)min vs. (18.9±3.0)min],lymph nodes (LN) clearing[(17.0±1.9) vs. (17.6±2.2)] and postoperative hospital stay[(14.7±5.0)d vs. (13.0±2.0)d]. However,anastomosis related complications in the Con-DSG group were more than those in the Mod-DSG group,the difference was statistically significant(P<0.05). Conclusion Laparoscopic Mod-DSG is a safe and feasible digestive tract reconstruction pattern with definite short term effect ,can make the patients to obtain benefit and is worth promotion as a digestive tract reconstruction pattern.%目的：探讨远端胃癌根治术运用改良三角吻合技术的近期疗效。方法选取重庆医科大学附属第二医院胃肠外科2014年2月至2016年2月施行的全腹腔镜远端胃癌根治术（TLDG）67例，其中传统三角吻合（Con-DSG组）35例，改良三角吻合（Mod-DSG组）32例，回顾性对比分析两组患者淋巴结清扫、住院时间、吻合口大小、吻合时间、术后并发症、非计划再次手术等情况。结果两组患者吻合口直径[（28.7±3.1）mm vs.（29.9±3.1）mm]、消化道重建时间[（19.0±3.1）min vs.（18.9±3.0）min]、淋巴结清扫[（17.0±1.9）枚vs.（17.6±2.2）枚]、住院时间[（14.7±5.0）d vs.（13.0±2.0）d]比较，差异均无统计学意义（P>0.05），二者非计划再次手术率比较，差异无统计学意义（P>0.05）；但Con-DSG组术后总并发症发生率高于Mod-DSG组，差异有统计学意义（P<0.05），其中Con-DSG组吻合口相关并发症发生率高于Mod-DSG组，差异有统计学意义（P<0.05）。结论腹腔镜下改良三角吻合技术是一项安全、可行的消化道重建方式，近期疗效确切，能使患者获益，值得推广。