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目的探讨腹腔镜胃癌根治术残胃或食道空肠双襻吻合的临床疗效。方法回顾性分析2008年3月至2014年12月对18例腹腔镜胃癌根治术残胃或食道空肠双襻吻合重建术患者的临床资料。行根治性全胃切除术8例,远端胃大部切除术10例。从腹腔镜腹部手术时间、术中出血量、淋巴结清扫数目、术后肛门排气时间、术后住院时间,术后并发症发生率、术后胃排空功能、3年局部肿瘤复发率等评价手术质量。采用门诊和电话方式进行随访,随访时间至2015年3月。结果 18例患者均成功实施腹腔镜胃癌根治术。全胃切除术平均238 min,远端胃切除术217 min。术中平均出血量180 ml,平均清扫淋巴结16枚。术后肠蠕动恢复、肛门排气时间平均为3.6 d,平均术后住院时间为12.6 d。残胃与空肠双襻、空肠与空肠侧侧吻合重建方式,术后发生胃排空障碍2例(11.1%),经有效胃肠减压,营养支持等保守治疗5~12 d胃排空障碍解除。无手术切缘癌残留,无围手术期死亡。术后18例患者随访时间截止2015年3月(3~84个月),无肿瘤复发和转移,术后患者生活质量较好。结论腹腔镜胃癌根治术残胃或食道空肠双襻圆形吻合器吻合术安全、可行,术后恢复快和并发症少,术后能维持较好消化吸收功能,其近期效果比较满意,远期效果待进一步观察。
Objective To investigate the clinical efficacy of laparoscopic radical gastrectomy or gastrointestinal jejunum anastomosis. Methods The clinical data of 18 patients undergoing laparoscopic radical gastrectomy or esophageal jejunostomy reconstruction from March 2008 to December 2014 were retrospectively analyzed. Radical gastrectomy in 8 cases, distal gastrectomy in 10 cases. From laparoscopic abdominal operation time, intraoperative blood loss, the number of lymph node dissection, postoperative anal exhaust time, postoperative hospital stay, postoperative complications, postoperative gastric emptying function, 3 years local tumor recurrence rate evaluation Quality of surgery. Follow-up was conducted by outpatient clinic and telephone interview until March 2015. Results All the 18 patients underwent laparoscopic radical gastrectomy. Total gastrectomy average 238 min, distal gastrectomy 217 min. Intraoperative average blood loss of 180 ml, an average of 16 lymph node dissection. Postoperative bowel recovery, the average time of anus exhaust was 3.6 d, the average postoperative hospital stay was 12.6 d. Gastric emptying and jejunum double 襻, jejunum and jejunum lateral anastomosis reconstruction method, postoperative gastric emptying disorders in 2 cases (11.1%), effective gastrointestinal decompression, nutritional support and other conservative treatment of 5 ~ 12 d gastric emptying disorders Lifted Surgical margin excision, no perioperative death. After the operation, 18 patients were followed up until March 2015 (3 to 84 months), no tumor recurrence and metastasis, the quality of life of postoperative patients was better. Conclusions Laparoscopic radical gastrectomy or esophagogastric jejunum circular stapler anastomosis is safe, feasible, quick recovery and less complications after operation, and can maintain better digestion and absorption function after operation. The short-term effect is satisfactory. The long-term Effect to be further observed.