摘要目的 比较远端胃癌根治性切除术毕Ⅱ式吻合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 回顾性纳入2013年1月至2017年4月期间北京大学肿瘤医院胃肠肿瘤中心四病区所有接受腹腔镜辅助或开腹根治性远端胃大部切除术的胃腺癌患者临床资料.排除:(1)术前临床分期及术后病理学分期检查证实为Ⅳ期的胃癌患者;(2)因消化道穿孔、梗阻、出血等行急诊手术者;(3)术前曾行化疗治疗;(4)因肿瘤侵犯其他脏器行联合脏器切除者;(5)合并有其他恶性肿瘤病史者.共纳入116例胃癌患者.根据胃肠吻合手术采用吻合器的不同,分为圆形吻合器组(61例,52.6%)和直线吻合器组(55例,47.4%).比较两组患者术中及术后情况.结果 两组患者基线资料的差异无统计学意义(P> 0.05),具有可比性.直线吻合器组和圆形吻合器组患者的手术时间(平均数:230 min比234 min)、术中出血量(中位数:50.0 ml比50.0 ml)、淋巴结清扫数目(中位数:28.0枚比26.0枚)以及阳性淋巴结数目(中位数:1.0枚比2.0枚)的差异均无统计学意义(均P> 0.05).相比圆形吻合器组,直线吻合器组患者术后首次排气时间(中位数:3.0 d比4.0 d,P=0.038)、首次进食时间(中位数:7.0 d 比8.0 d,P=0.000)、首次拔除腹腔引流管时间(中位数:7.0 d比9.0 d,P=0.000)及术后住院时间(中位数:8.0 d 比10.0 d,P=0.000)均更短,差异具有统计学意义;而两组术后并发症发生率分别为1.8%(1/55)和11.5%(7/61),差异无统计学意义(P=0.092).圆形吻合器组术后发生吻合口出血1例(1.6%),出现胃排空障碍和腹腔感染各3例(4.9%),均经保守治疗痊愈,未发生十二指肠残端瘘,未行二次手术治疗;直线吻合器组患者术后仅1例(1.8%)患者发生十二指肠残端瘘,并行二次手术治疗,无其他严重并发症的发生.结论在远端胃癌根治性切除术毕Ⅱ式吻合术中,应用直线吻合器患者在术后胃肠道功能恢复更快,患者住院时间更短,更具优势.

abstractsObjective To compare the safety and effectiveness of circular stapler and linear stapler in Billroth Ⅱ anastomosis following distal gastrectomy for gastric cancer patients. Methods Clinical data of gastric adenocarcinoma patients who received distal gastrectomy with BillrothⅡanastomosis at Ward Ⅳ of Gastrointestinal Cancer Center of Peking University Cancer Hospital from January 2013 to April 2017 were collected retrospectively. Exclusion criteria: (1) patients identified as stage Ⅳ gastric cancer by preoperative clinical and postoperative pathological staging. (2)patients undergoing emergency operation due to perforation, obstruction, or bleeding of digestive tract. (3) patients receiving chemotherapy before operation. (4) patients undergoing combined organ resection due to tumor involving other organs (5) patients complicating with other malignancies. A total of 116 cases were enrolled and divided into circular stapler (CS,61 cases)group and linear stapler (LS,55 cases)group according to the application of mechanical stapler. Clinicopathological characteristics, operative conditions and postoperative recovery were compared between two groups.Results Differences in baseline data,such as tumor size,Lauren classification,differentiation grade,and pathologic stage,between two groups were not statistically significant (all P>0.05). The mean operative time (230 min vs. 234 min), median intra-operative blood loss(50.0 ml vs.50.0 ml),median number of harvested lymph node(28.0 vs.26.0)and median number of positive lymph node(1.0 vs.2.0)between LS group and CS group were not significantly different (all P> 0.05) As compared to CS group, LS group presented shorter median time to the first flatus (3.0 days vs.4.0 days,P=0.038),shorter median time to the first liquid diet (7.0 days vs.8.0 days,P=0.000),shorter median time to remove the first abdominal drainage tube(7.0 days vs.9.0 days, P= 0.000) and shorter median time of postoperative hospital stay (8.0 days vs.10.0 days, P=0.000). The morbidity of postoperative complication was 11.5% and 1.8% in CS group and LS group respectively without significant difference (P = 0.092). In CS group, 1 case (1.6%) developed anastomotic hemorrhage, 3 cases (4.9%) gastric emptying disorder and 3 cases (4.9%) abdominal infection after operation,who all were cured by conservative treatment without duodenal stump fistula and re-operation.In LS group, only 1 case (1.8%) developed duodenal stump fistula and was cured by re-operation. Conclusion In distal gastrectomy with BillrothⅡanastomosis for gastric cancer,the application of linear stapler results in faster recovery of gastrointestinal function and shorter hospital stay, indicating more advantages.