Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes
Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes
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DOI：
10.1007/s10120-014-0337-3
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发表时间：
2015-01-01
期刊：
影响因子：
7.4
通讯作者：
Yamaguchi, Toshiharu
中科院分区：
文献类型：
--
作者：
Kumagai, Koshi;Hiki, Naoki;Yamaguchi, Toshiharu
早期胃癌(EGC)的腹腔镜辅助保留幽门胃切除术(LAPPG)的可行性、安全性和术后生活质量的改善已被证实。本文报告了60例中胃EGC患者行全腹腔镜保留幽门胃切除术(TLPPG)的手术方法和近期疗效。在切除淋巴结和胃活动后，术中进行胃镜检查以确定肿瘤的位置，然后分别在幽门环5 cm和Demel线近端建立远端和近端的横断线。胃横断后，用直线式吻合器行三角形体内胃吻合术，无术中并发症及中转开放手术。平均手术时间259分钟，平均出血量28毫升。术后并发症按Clavien-Dindo分级为II级者12例(20.0%)，最常见的并发症为胃淤滞(6例，10.0%)。术后严重并发症发生率为1.7%以上，仅1例因术后腹内出血及继发多器官功能衰竭而需再次手术及重症监护。TLPPG采用三角形体内吻合术是一种安全的手术方法，但其手术时间往往长于传统的手缝胃吻合术。
The feasibility, safety, and improved quality of postoperative life following laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with a hand-sewn anastomosis via a mini-laparotomy for early gastric cancer (EGC) have been previously established. Here we describe the surgical procedure of totally laparoscopic pylorus-preserving gastrectomy (TLPPG) using an intracorporeal delta-shaped anastomosis technique, and the short-term surgical outcomes of 60 patients with EGC in the middle stomach are reported.After lymphadenectomy and mobilization of the stomach, intraoperative gastroscopy was performed in order to verify the location of the tumor, and then the distal and proximal transecting lines were established, 5 cm from the pyloric ring and just proximal to Demel's line, respectively. Following transection of the stomach, a delta-shaped intracorporeal gastrogastrostomy was made with linear staplers.There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 259 min and 28 mL, respectively. Twelve patients (20.0 %) experienced postoperative complications classified as grade II using the Clavien-Dindo classification, with the most frequent complication being gastric stasis (6 cases, 10.0 %). The incidence of severe complications classified as grade III or above was 1.7 %; only one patient required reoperation and intensive care due to postoperative intraabdominal bleeding and subsequent multiple organ failure.TLPPG with an intracorporeal delta-shaped anastomosis was found to be a safe procedure, although it tended to require a longer operating time than the well-established LAPPG with a hand-sewn gastrogastrostomy.