完全腹腔镜全胃切除术手工荷包缝合法与腹腔镜辅助全胃切除术的疗效比较

doi:10.3969/j.issn.1005-6483.20240798

摘要/Abstract

摘要： 目的探讨在完全腹腔镜全胃切除术中手工荷包缝合法行食管空肠管状吻合的应用价值。方法 2020年1月～2023年12月收治胃癌病人41例，根据手术方法分为两组，完全腹腔镜组22例，采用完全腹腔镜根治性全胃切除术手工荷包缝合法，腹腔镜辅助组19例，行传统腹腔镜辅助全胃根治性切除术。结果 41例病人均顺利完成手术，无中转开腹，无围手术期死亡。完全腹腔镜组和腹腔镜辅助组手术时间分别为397.50(310~540)分钟、350(250~440)分钟，术中出血量分别为50(10~400)ml、100(20~200)ml，切口长度分别为5(4~5)cm、8(6~10)cm，术后止痛药使用时间分别为4(3~5)天、5(3~5)天，住院时间分别为23(18~37)天、26(13~34)天，两组比较差异有统计学意义(P<0.05)；两组病人的淋巴结清扫数目、术后腹腔出血、术后吻合口漏、术后吻合口狭窄、术后肺部感染、术后首次排气时间及术后下床时间相比，差异无统计学意义(P＞0.05)。结论在完全腹腔镜全胃切除术中采用手工荷包缝合法行食管空肠管状吻合安全可行，与传统的腹腔镜辅助全胃根治性切除手术比较，手术切口更小、术中出血量更少、术后疼痛感更轻、住院时间更短，但是手术时间更长。

关键词: 胃癌, 完全腹腔镜, 全胃切除术, 管型吻合器, 手工荷包缝合法

Abstract: Objective To explore the application value of manual purse-string suture in esophageal jejunum tubular anastomosis in total laparoscopic total gastrectomy.Methods A retrospective cohort study was conducted to collect the clinical data of 41 patients with gastric cancer who underwent laparoscopic total gastrectomy in the Department of Gastrointestinal Surgery,Jingmen Central Hospital from January 2020 to December 2023.Among them,22 cases underwent total laparoscopic radical total gastrectomy with manual purse-string suture (total laparoscopic group),Nineteen patients underwent traditional laparoscopic-assisted total gastrectomy (laparoscopic-assisted group).Results 41 patients were successfully completed surgery,no conversion to laparotomy,no perioperative death.The operation time of the total laparoscopic group and laparoscopic-assisted group was 397.50 (310-540) minutes and 350 (250-440) minutes.The intraoperative blood loss was 50 (10-400) ml and 100 (20-200) ml.The incision length was 5 (4-5) cm and 8 (6-10) cm.The duration of postoperative analgesic use was 4 (3-5) days and 5 (3-5) days.The hospitalization days were 23 (18-37) days and 26 (13-34) days,respectively,and the difference was statistically significant (P<0.05).There was no significant difference in the number of lymph node dissection,postoperative abdominal bleeding,postoperative anastomotic leakage,postoperative anastomotic stenosis,postoperative pulmonary infection,postoperative first exhaust time and postoperative ambulation time between the two groups (P> 0.05).Conclusion It is safe and feasible to perform esophagojejunostomy by hand purse-string suture in totally laparoscopic total gastrectomy.Compared with traditional laparoscopic-assisted total gastrectomy,it has smaller incision,less intraoperative blood loss,less postoperative pain,shorter hospitalization time,but longer operation time.

Key words: gastric cancer, complete laparoscopic, total gastrectomy, tubular stapler, improved reverse puncture method

苏纯洁, 孙念. 完全腹腔镜全胃切除术手工荷包缝合法与腹腔镜辅助全胃切除术的疗效比较[J]. 临床外科杂志, 2025, 33(4): 401-404.

SU Chunjie, SUN Nian. Comparison of the efficacy of manual purse-string suture complete laparoscopic total gastrectomy and laparoscopic assisted total gastrectomy[J]. JOURNAL OF CLINICAL SURGERY, 2025, 33(4): 401-404.

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