Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience
Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience
复制标题
DOI：
10.1007/s00464-007-9446-y
复制
发表时间：
2008-02-01
影响因子：
3.1
通讯作者：
Park, Seung Man
中科院分区：
文献类型：
--
作者：
Kim, Jin-Jo;Song, Kyo Young;Park, Seung Man
背景我们分析了我们的初步临床资料完全腹腔镜胃切除术（TLG），以评估其有效性方面的微创，技术可行性和safety.Methods 45例连续患者在我们的机构接受TLG在2004年6月和2006年2月参加了这项研究。有26名男性和19名女性，平均年龄为58.8岁，平均体重指数（BMI）为23.2。结果胃癌41例，良性疾病3例，胃肠道间质瘤1例，行远端胃切除术40例，全胃切除术4例，保留幽门胃切除术1例。在远端胃切除术中，Billroth I（25例）是最常见的手术，其次分别是未切割Roux-en-Y胃空肠吻合术（14例）和Billroth II（1例）。平均手术时间为314分钟，平均吻合时间为41分钟，平均使用斯台普斯数量为8个，平均估计失血量为150 ml。没有转为开放手术的病例。在2.9天时观察到第一次排气，并在3.7天时开始流食。除病人自控镇痛（PCA）外，平均术后镇痛次数为1.4次，平均术后住院时间为11天。术后并发症6例（13.3%），无手术死亡.有2例胃排空延迟，1例吻合口瘘、吻合口狭窄、腹腔内出血和腹壁疝。结论腹腔镜直线型吻合器行TLG椎管内吻合术安全可行，手术创伤小，术后恢复良好。
Background We analyzed our preliminary clinical data for totally laparoscopic gastrectomy (TLG) in order to evaluate its effectiveness in terms of minimal invasiveness, technical feasibility, and safety.Methods Forty-five consecutive patients who underwent TLG in our institution between June 2004 and February 2006 were enrolled in this study. There were 26 men and 19 women, with a mean age of 58.8 years and a mean body mass index (BMI) of 23.2. In all cases, only laparoscopic linear staplers were used for intracorporeal anastomosis.Results The reasons that gastrectomy was performed were adenocarcinoma in 41 cases, benign disease in three cases and gastrointestinal stromal tumor in one case, and the types of surgery were distal gastrectomy (40), total gastrectomy (four) and pylorus-preserving gastrectomy (one). Among the distal gastrectomies, Billroth I (25) was the most frequent procedure, followed by uncut Roux-en-Y gastrojejunostomy (14) and Billroth II (one), respectively. The mean operation time was 314 minutes, the mean anastomotic time was 41 minutes, the mean number of staples used was eight, and the mean estimated blood loss was 150 ml. There was no case of conversion to an open procedure. The first flatus was observed at 2.9 days, and liquid diet was started at 3.7 days. The mean number of postoperative analgesic use, except for patient-controlled analgesia (PCA), was 1.4 times, and the mean postoperative hospital stay was 11 days. Postoperative complication occurred in six patients (13.3 %), but no postoperative mortality occurred. There were two cases of delayed gastric empting and one case of anastomotic leakage, anastomotic stenosis, intraabdominal bleeding, and ventral hernia each. All of the patients recovered well with conservative or surgical management.Conclusions TLG with intracorporeal anastomosis using laparoscopic linear staplers was safe and feasible, and we were able to obtain acceptable surgical outcomes in terms of minimal invasiveness.