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目的评估腹腔镜全胃切除术中应用圆形吻合器与直线吻合器实施消化道重建的安全性和有效性。方法回顾性分析自2012年3月至2016年4月期间北京大学肿瘤医院胃肠肿瘤中心一病区接受腹腔镜辅助或全腹腔镜全胃切除术的胃癌病人资料,比较采用不同吻合器类型病人临床病理特点、手术特点和术后恢复情况,采用Logistic回归分析判断术后并发症的危险因素。结果共纳入72例病人,采用圆形吻合器行腹腔镜辅助重建47例,采用直线吻合器行全腹腔镜重建25例。两组病人年龄、性别、体重指数(BMI)、肿瘤大小、Lauren分型、分化程度及分期方面差异无统计学意义(P>0.05)。直线吻合器组病人接受术前治疗比例更低(4.0%vs.27.7%,P=0.026)。圆形吻合器组和直线吻合器组中位手术时间分别为247 min和258 min,中位术中出血量分别为100 m L和50 m L,差异均无统计学意义(P>0.05)。手术根治程度、淋巴结清扫数目及近端切缘距离方面同样差异无统计学意义。直线吻合器组病人术后首次进全流食时间更短(3.5 d vs.5.0 d,P=0.030),术后住院时间、术后首次排气时间、首次进半流食时间及术后首次拔除腹腔引流管时间差异无统计学意义。两组病人术后并发症发生率分别为25.5%和32.0%,差异无统计学意义(P=0.560)。病人临床病理特点及手术相关因素进行单因素分析均未提示和术后并发症相关。结论应用机械吻合方法行腹腔镜全胃切除手术安全可行,直线吻合器进行全腹腔镜下和圆形吻合器腹腔镜辅助切口下进行消化道重建在手术时间、出血量、术后风险等方面相当,且直线吻合器组全腹腔镜下重建术后胃肠道功能恢复可能更快。
Objective To evaluate the safety and effectiveness of circular stapler and linear stapler in gastrointestinal reconstruction during laparoscopic total gastrectomy. Methods The data of patients with gastric cancer undergoing laparoscopic or total laparoscopic total gastrectomy in a district of Gastrointestinal Cancer Center of Peking University Cancer Hospital from March 2012 to April 2016 were retrospectively analyzed. The data of patients with different stapler types Clinicopathological characteristics, surgical characteristics and postoperative recovery, Logistic regression analysis to determine the risk factors for postoperative complications. Results A total of 72 patients were enrolled. Among them, 47 cases were assisted by laparoscopic assisted stapling and 25 cases were reconstructed by laparoscopic linear stapler. There was no significant difference in age, gender, body mass index (BMI), tumor size, Lauren classification, differentiation and staging between the two groups (P> 0.05). Patients in the linear stapler group had a lower percentage of preoperative therapies (4.0% vs.27.7%, P = 0.026). The median operative time was 247 min and 258 min in the stapling group and the linear stapler group respectively. The median bleeding volume was 100 m L and 50 m L, respectively, with no significant difference (P> 0.05). There was no significant difference in the degree of radical surgery, the number of lymph node dissection and the distance of proximal incision. The patients who underwent linear stapler surgery had shorter total fluid flow (3.5 d vs. 5.0 d, P = 0.030), postoperative hospital stay, first postoperative exhaust time, first partial flow of food, and first postoperative ablation Drainage tube time difference was not statistically significant. The incidence of postoperative complications in both groups were 25.5% and 32.0%, respectively, with no significant difference (P = 0.560). The clinicopathological characteristics of patients and surgery-related factors univariate analysis showed no correlation with postoperative complications. Conclusions The laparoscopic total gastrectomy is safe and feasible with mechanical anastomosis. The laminectomy with linear stapler and laparoscopic anastomosis assisted with linear stapler for gastrointestinal reconstruction is equivalent in operation time, blood loss and postoperative risk , And linear stapler group after complete laparoscopic reconstruction of gastrointestinal function recovery may be faster.