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腹腔镜技术作为一门新兴的技术在胃癌中的应用越来越频繁,并且其具有创伤小、病人恢复时间快、痛苦少等优点[1-2],手术适应证也由早期逐步过渡到进展期,甚至联合脏器切除[3-4]。相对来说,与传统的胃癌手术比较,腹腔镜胃癌手术的消化道重建方式有其自身独特的特点和创新空间[5]。胃癌术后,胃肠内容物反流是其常见的并发症,会引起胃食管黏膜的化学性损伤,而吸入则可导致严重的消化道和呼吸道并发症[6],另外还可引起残胃癌变[7]。针对腹腔镜下胃癌手术后病人胃肠内容物反流的相关因素,本研究就中国人民解放军联勤保障部队第940医院普外科2008年1月至2015年6月开展的1 835台腹腔镜胃癌手术以及术后随访进行归纳总结,探讨腹腔镜技术下新的消化道重建方式降低胃肠内容物反流的措施。
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毕Ⅰ式吻合、毕Ⅱ式吻合、胃空Roux-en-Y吻合及三角吻合术后发生反流率分别为10.1%、17.7%、4.61%及2.86%,三角吻合技术联合R型代胃,有效解决吻合口狭窄及反流(P<0.01)(见表 1)。
分组 n Ⅰ级 Ⅱ级 Ⅲ+Ⅳ级 合计 Hc P 毕Ⅰ式 386 13 21 5 39 毕Ⅱ式 1 002 39 67 71 177 胃空Roux-en-Y 412 9 7 3 19 13.61 <0.01 三角吻合 35 1 0 0 1 合计 1 835 62 95 79 236 表 1 不同消化道重建方式反流情况比较
不同消化道重建方式对腹腔镜胃癌术后反流的影响
Effect of different reconstruction ways of digestive tract on the reflux after laparoscopic gastric cancer surgery
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摘要:
目的分析腹腔镜胃癌术后胃肠反流的相关因素并探讨具体的诊疗措施。 方法回顾分析1 835例行腹腔镜胃癌术后病人的临床资料,其中实施胃十二指肠吻合(毕Ⅰ式)386例,胃空肠吻合(毕Ⅱ式) 1 002例,胃空Roux-en-Y吻合412例,三角吻合35例。 结果毕Ⅰ式术后发生Ⅰ级反流13例,Ⅱ级反流21例,Ⅲ+Ⅳ级反流5例。毕Ⅱ式术后发生Ⅰ级反流39例,Ⅱ级反流67例,Ⅲ+Ⅳ级反流71例。胃空Roux-en-Y吻合术后发生Ⅰ级反流9例,Ⅱ级反流7例,Ⅲ+Ⅳ级反流3例。三角吻合术后发生Ⅰ级反流1例,无Ⅱ、Ⅲ、Ⅳ级反流者。 结论三角吻合在腹腔镜胃癌手术中具有较为明显抗反流的优势。 Abstract:ObjectiveTo analyze the related factors of the gastrointestinal reflux after laparoscopic gastric cancer surgery, and explore its treatment measures. MethodsThe clinical data of 1835 patients treated with laparoscopic gastric cancer surgery were retrospectively analyzed.Three hundred and eighty-six cases were treated with gastroduodenal anastomosis(B-Ⅰ type), 1002 cases were treated with gastric jejunum anastomosis(B-Ⅱ type), 412 cases were treated with stomach empty Roux-en-Y anastomosis, and 35 cases were treated with triangle anastomosis. ResultsPostoperative stageⅠreflux in 13 cases, stage Ⅱ reflux in 12 cases, stage Ⅲ and Ⅳ reflux in 5 cases were identified in the patients treated with B-Ⅰtype anastomosis.Postoperative stageⅠreflux in 39 cases, stage Ⅱ reflux in 67 cases, stage Ⅲ and Ⅳ reflux in 71 cases were identified in the patients treated with B-Ⅱtype anastomosis.Postoperative stageⅠreflux in 9 cases, stage Ⅱ reflux in 7 cases, stage Ⅲ and Ⅳ reflux in 3 cases were identified in the patients treated with stomach empty Roux-en-Y anastomosis.Postoperative stageⅠreflux in 1 case, and no stage Ⅱ, Ⅲ and Ⅳ reflux case were identified in the patients treated with triangle anastomosis. ConclusionsLaparoscopic triangle anastomosis in gastric cancer surgery has more obvious advantages of anti-reflux. -
Key words:
- gastric neoplasms /
- laparoscopic technique /
- reflux /
- digestive tract reconstruction
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表 1 不同消化道重建方式反流情况比较
分组 n Ⅰ级 Ⅱ级 Ⅲ+Ⅳ级 合计 Hc P 毕Ⅰ式 386 13 21 5 39 毕Ⅱ式 1 002 39 67 71 177 胃空Roux-en-Y 412 9 7 3 19 13.61 <0.01 三角吻合 35 1 0 0 1 合计 1 835 62 95 79 236 -
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