【摘要】：目的探討腹腔鏡根治性近端胃或全胃切除術(shù)中3種吻合器釘座置入方法的優(yōu)缺點。方法回顧分析我院2014年5月~2015年12月由同一組醫(yī)生完成的53例腹腔鏡根治性近端胃或全胃切除的臨床資料,將17例采用輔助小切口置入吻合器釘座設(shè)為A組,16例采用經(jīng)口置入釘鉆系統(tǒng)(Or Vil)設(shè)為B組,20例采用反穿刺技術(shù)(reverse puncture device,PRD)設(shè)為C組,比較3組患者手術(shù)時間、釘座置入時間、術(shù)中出血、術(shù)后排氣時間、住院時間、腹部切口長度、食管近切緣長度。結(jié)果 53例均順利完成手術(shù),圍手術(shù)期無死亡。3組術(shù)中出血量[(158.8±34.4)ml vs.(136.2±33.0)ml vs.(160.2±35.6)ml,F=2.57,P=0.087]、肛門排氣時間[2.0(1.0~12.5)d vs.1.5(1.0~2.5)d vs.1.5(1.0~3.0)d,χ~2=4.405,P=0.111]和并發(fā)癥發(fā)生率[11.8%(2/17)vs.18.8%(3/16)vs.25.0%(5/20),χ~2=1.052,P=0.591]差異無統(tǒng)計學(xué)意義。A組釘座置入時間(18.5±4.8)min最短,顯著短于B組(34.9±8.8)min(q=10.465,P0.05)和C組(23.1±5.1)min(q=3.099,P0.05)。C組食管切緣長度(4.5±0.5)cm最長,與B組(4.4±0.6)cm相比無統(tǒng)計學(xué)差異(q=0.583,P0.05),但顯著長于A組(2.5±1.0)cm(q=11.856,P0.05)。B組切口長度(4.3±0.5)cm最短,與C組(4.5±0.6)cm相比無統(tǒng)計學(xué)差異(q=0.662,P0.05),但顯著短于A組(8.6±2.1)cm(q=13.704,P0.05)。A組手術(shù)時間(208.5±24.4)min,顯著短于B組(232.8±23.4)min(q=4.577,P0.05),但與C組(214.5±17.0)min比較無統(tǒng)計學(xué)差異(q=1.193,P0.05)。結(jié)論 3種吻合器釘座置入方法均安全可靠,輔助切口置入釘座可選擇合適患者開展;Or Vil、RPD能避免體形限制,獲得更長切緣;RPD操作更為簡便,可作為腹腔鏡下食管-殘胃(空腸)吻合中理想的釘座置入方法進行推廣。
[Abstract]:Objective to investigate the advantages and disadvantages of three stapler placement methods in laparoscopic proximal gastrectomy or total gastrectomy. Methods the clinical data of 53 cases of laparoscopic proximal gastrectomy or total gastrectomy performed by the same group of doctors in our hospital from May 2014 to December 2015 were retrospectively analyzed. Seventeen cases were divided into group A (n = 16), group B (n = 20), group B (n = 20) using (reverse puncture device technique. The time of operation and placement of nail pedestal were compared among the three groups. Intraoperative bleeding, postoperative exhaust time, hospital stay, abdominal incision length, esophageal proximal incisor length. 緇撴灉 53渚嬪潎欏哄埄瀹屾垚鎵嬫湳,鍥存墜鏈湡鏃犳浜，

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