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目的探讨胃十二指肠三角吻合在全腹腔镜远端胃癌切除术(totally laparoscopic distal gastrectomy,TLDG)中应用的可行性。方法回顾性收集2013年12月至2015年12月期间于孝感市第一人民医院行TLDG或腹腔镜辅助远端胃癌切除术(laparoscopic assisted distal gastrectomy,LADG)的90例胃癌患者的临床资料。其中行TLDG 45例(TLDG组),行LADG 45例(LADG组)。比较2组患者的手术时间、术中出血量、消化道重建时间、近远端切缘距离、清扫淋巴结数量、术后肛门首次排气时间、术后开始饮水时间、术后开始进食半流质饮食时间、住院时间及并发症发生情况,评价胃十二指肠三角吻合应用于TLDG的可行性。结果 1术中情况。TLDG组患者的手术时间、消化道重建时间及远端切缘距离均长于(大于)LADG组(P<0.050),术中出血量少于LADG组,但2组患者的清扫淋巴结数量及近端切缘距离比较差异均无统计学意义(P>0.050)。2术后情况。2组患者的术后肛门首次排气时间、术后开始饮水时间、术后开始进食流质饮食时间、住院时间及并发症发生率比较差异均无统计学意义(P>0.050)。术后所有患者均获得6个月及以上的随访,随访时间为6~16个月,中位数为10个月。随访期间,2组均未见肿瘤复发患者,也未见明显的吻合口狭窄或吻合口梗阻患者。结论 TLDG中应用胃十二指肠三角吻合重建消化道具有良好的可行性及安全性,是胃癌患者消化道重建的可靠方法,值得在临床上推广应用。
Objective To investigate the feasibility of gastroduodenal anastomosis in total laparoscopic distal gastrectomy (TLDG). Methods The clinical data of 90 gastric cancer patients who underwent TLDG or laparoscopic assisted distal gastrectomy (LADG) from December 2013 to December 2015 were retrospectively collected. Among them, 45 patients underwent TLDG (TLDG group) and 45 patients underwent LADG (LADG group). The operation time, intraoperative blood loss, digestive tract reconstruction time, proximal and distal incision distance, the number of lymph nodes dissected, the time of the first postoperative anal exhaust, the time of drinking water after the operation were compared, and the semi-liquid diet Time, hospital stay and complications, evaluate the feasibility of gastroduodenal anastomosis applied to TLDG. Results 1 intraoperative situation. The operation time, digestive tract reconstruction time and distal incision distance of patients in TLDG group were longer than (greater than) LADG group (P <0.050), blood loss was less in LADG group than in LADG group, but the number of lymph nodes and proximal end There was no significant difference in the margins between the two groups (P> 0.050). 2 postoperative situation. There was no significant difference between the two groups (P> 0.050) after the first time of anus, the beginning of drinking water, the time of starting to eat liquid diet, the length of hospital stay and the complication rate. All patients were followed up for 6 months or more, with a follow-up time of 6 to 16 months and a median of 10 months. During the follow-up period, no recurrence was observed in the two groups, and no obvious anastomotic stricture or anastomotic obstruction was observed. Conclusions The application of gastroduodenal anastomosis to reconstruct gastrointestinal tract in TLDG has a good feasibility and safety. It is a reliable method of gastrointestinal reconstruction in patients with gastric cancer, which is worth popularizing in clinic.