An Effective Duodenum Bulb Mobilization for Extracorporeal Billroth I Anastomosis of Laparoscopic Gastrectomy
An Effective Duodenum Bulb Mobilization for Extracorporeal Billroth I Anastomosis of Laparoscopic Gastrectomy
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DOI：
10.1007/s11605-008-0686-5
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发表时间：
2009-02-01
影响因子：
3.2
通讯作者：
Yamaguchi, Toshiharu
中科院分区：
文献类型：
--
作者：
Hiki, Naoki;Fukunaga, Testsu;Yamaguchi, Toshiharu
对于肥胖、体型大或残胃小的患者，由于需要将十二指肠残端抬出伤口外，体外圆钉Billroth I （B-I）吻合术比较困难。本研究的目的是评估环钉B-I重建在腹腔镜辅助远端胃切除术（LADG）中有效十二指肠动员的可行性。2005年3月至2007年12月，199例早期胃癌患者在癌症研究所胃肠外科接受了LADG和B-I重建。由四层膜层组成的大网膜被完全剥离，以便有效地动员十二指肠球，以便于进行体外端到端胃十二指肠吻合术。一些临床病理生理特征与吻合并发症，包括吻合口瘘，狭窄，出血和溃疡，进行了评估。199例体外圆钉B-I吻合成功率为100%，其中24%的患者体重指数大于25。吻合口术后并发症发生率为2%。本研究未见吻合口漏。2例（1%）患者出现吻合口狭窄，1例（0.5%）患者出现吻合口出血，1例（0.5%）患者出现吻合口溃疡。所有并发症均采取保守处理。无术后死亡率。通过完全剥离大网膜实现可行的十二指肠球动员，可以方便地进行体外B-I吻合，并将LADG吻合相关的并发症降至最低。
Extracorporeal circular-stapled Billroth I (B-I) anastomosis is difficult in patients with obesity, a large body shape, or small remnant stomach, as it requires the duodenal stump to be lifted outside of the wound. The aim of this study was to evaluate the feasibility of circular-stapled B-I reconstruction for laparoscopy-assisted distal gastrectomy (LADG) with effective duodenal mobilization.Between March 2005 and December 2007, 199 patients with early gastric cancer underwent LADG with B-I reconstruction in the Department of Gastrointestinal Surgery at the Cancer Institute. The greater omentum, comprised of four membrane layers, was completely dissected for effective duodenal bulb mobilization to allow easy performance of extracorporeal end-to-end gastroduodenostomy. Several clinicopathophysiological features relating to anastomosis complications, including anastomotic leakage, stenosis, bleeding, and ulcers, were evaluated.The success rate of extracorporeal circular-stapled B-I anastomosis was 100% for the 199 patients, 24% of whom had a body mass index greater than 25. The rate of anastomosis-related postoperative complications was 2%. Anastomotic leakage was not observed in this study. Anastomotic stenosis was observed in 2 (1%) patients, anastomotic bleeding was observed in 1 (0.5%) patient, and anastomotic ulcer was diagnosed in 1 (0.5%) patient. All these complications were managed conservatively. There was no postoperative mortality.Feasible duodenal bulb mobilization by complete dissection of the greater omentum allows easy performance of extracorporeal B-I anastomosis and minimizes complications related to anastomosis in LADG.