|本期目录/Table of Contents|

[1]林 密,黄昌明,郑朝辉,等.全腹腔镜改良三角吻合技术在局部进展期远端胃癌中的应用[J].福建医科大学学报,2015,49(05):288-293.
 LIN Mi,HUANG Changming,ZHENG Chaohui,et al.The Application of Totally Laparoscopic Distal Gastrectomy with Modified Delta-shaped Gastroduodenostomy for Locally Advanced Gastric Cancer[J].Journal of Fujian Medical University,2015,49(05):288-293.
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《福建医科大学学报》[ISSN:1672-4194/CN:35-1192/R]

卷:
第49卷
期数:
2015年05期
页码:
288-293
栏目:
胃癌的基础与临床研究专题
出版日期:
2015-12-26

文章信息/Info

Title:
The Application of Totally Laparoscopic Distal Gastrectomy with Modified Delta-shaped Gastroduodenostomy for Locally Advanced Gastric Cancer
文章编号:
1672-4194(2015)05-0288-06
作者:
林 密 黄昌明 郑朝辉 李 平 谢建伟 林建贤
福建医科大学 附属协和医院胃外科,福州 350001
Author(s):
LIN Mi HUANG Changming ZHENG Chaohui LI Ping XIE Jianwei LIN Jianxian
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
关键词:
胃肿瘤/外科学 腹腔镜 腹腔镜检查 消化系统外科手术 吻合术外科 治疗结果
Keywords:
stomach neoplasms/surgery laparoscopes laparoscopy digestive system surgical procedures anastomosis surgical treatment outcome
分类号:
R443.8;R572
DOI:
-
文献标志码:
A
摘要:
目的 探讨全腹腔镜下改良三角吻合技术在治疗局部进展期远端胃癌中的安全性、可行性及近期疗效。 方法 原发性局部进展期胃远端癌患者85例,均施行全腹腔镜远端胃癌根治术并改良三角吻合技术治疗。收集并总结85例患者的临床病理特征、术中情况、术后情况及术后并发症发生情况,并对术后并发症发生的影响因素进行单因素和多因素的相关性分析。 结果 全组患者手术时间(157.6±28.4)min(90~225 min),吻合时间(12.9±4.1)min(7~29 min),术中出血量(51.3±34.3)mL(10~200 mL),排气时间(4.0±1.7)d(2~14 d),进食流质时间(5.4±2.2)d(2~15 d),进食半流质时间(8.4±3.2)d(4~25 d),术后住院时间(13.2±8.6)d(8~50 d)。术后出现吻合口漏4例,经保守治疗治愈;未出现吻合口狭窄、吻合口出血等其他吻合口相关并发症。单因素分析显示,体质量指数、术前胃癌伴出血与术后并发症的发生密切相关(P<0.05),其中,术前胃癌伴出血是影响术后并发症发生的独立危险因素(P<0.05)。中位随访时间14月,于术后12月因肿瘤复发死亡1例,尚无其他死亡或复发转移病例。 结论 全腹腔镜改良三角吻合术在局部进展期远端胃癌根治术中安全可行,操作简便,近期疗效满意,可以推广。
Abstract:
Objective The present study introduced a modified delta-shaped gastroduodenostomy and accessed its safety, feasibility and short term outcomes in patients undergoing totally laparoscopic distal gastrectomy for locally advanced gastric cancer. Methods A total of 85 patients with primary locally advanced distal gastric cancer undergoing totally laparoscopic distal gastrectomy with modified delta-shaped gastroduodenostomy between January 2013 and December 2014 were enrolled. The clinicopathologic characteristics, intraoperative outcomes, postoperative outcomes and postoperative complications were collected and summarized. Univariate and multivariate analyses were performed to estimate the predictive factors for postoperative morbidity. Results The male to female ratio of eligible patients included was 1.7∶1, with a mean age (60.5±13.6) years (range 24 to 87 years) and a mean BMI (22.2±3.4) kg/m2 (range 14.7 to 32.9 kg/m2). One patient was diagnosed as gastric cancer with pyloric obstruction and 12 with hemorrhage (presented with melena). Thirty-three patients (38.8%) were with comorbidity. The mean operation time was (157.6±28.4) min (range 90 to 225 min), the mean anastomosis time was (12.9±4.1) min (range 7 to 29 min), the mean blood loss was (51.3±34.3) mL (range 10 to 200 mL), and the mean times to first flatus, fluid diet, soft diet and postoperative hospital stay were (4.0±1.7) days (range 2 to 14 days), (5.4±2.2) days (range 2 to 15 days), (8.4±3.2) days (range 8 to 50 days), and (13.2±8.6) days (range 4 to 25 days), respectively. Four patients with minor anastomotic leakage after surgery were managed conservatively; no patient experienced any complications around the anastomosis, such as anastomotic stricture or anastomotic hemorrhage. Univariate analysis showed that BMI and gastric cancer with hemorrhage were significant factors that affected postoperative morbidity (P<0.05). Multivariate analysis found that gastric cancer with hemorrhage was the independent risk factor for the postoperative morbidity (P<0.05). The median follow-up time was 14 months. One patient died of tumor recurrence after 12 months, while no other patients had died or experienced recurrent or metastatic disease. Conclusions The modified delta-shaped gastroduodenostomy was technically safe and feasible, with easy operations and acceptable surgical outcomes, in patients undergoing totally laparoscopic distal gastrectomy for locally advanced gastric cancer. This procedure is a promising treatment for these patients.

参考文献/References:

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备注/Memo

备注/Memo:
收稿日期: 2015-06-23
基金项目: 国家自然科学基金(81441123);国家临床重点专科建设基金([2012]649);福建省科技计划重点项目(2014Y0025)
作者单位: 福建医科大学 附属协和医院胃外科,福州 350001
作者简介: 林 密(1988-),女,住院医师,医学硕士
通讯作者: 黄昌明. Email:hcmlr2002@163.com
更新日期/Last Update: 2015-12-26