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Title: [Overlap gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer].
Author: Zhang GN, Lu JY, Xu L, Sun XY, Xiao Y.
Journal: Zhonghua Wei Chang Wai Ke Za Zhi; 2019 Nov 25; 22(11):1064-1069. PubMed ID: 31770838.
Abstract:
Objective: The aim of the current study is to compare the short-term clinical outcomes between Billroth-I reconstruction using an overlap method and delta-shaped anastomosis in totally laparoscopic distal gastrectomy (TLDG). Method: A retrospective cohort study was performed. The following inclusion criteria were applied: (1) Preoperative gastroscopy and CT confirmed that the tumor is located in the antrum of the stomach, and the biopsy suggested adenocarcinoma; (2) Chest, abdomen and pelvis enhanced CT showed no evidence of distant metastasis; (3) Preoperative gastric reconstruction CT or endoscopic ultrasonography suggested that the clinical stage of the tumor is stage I-III. (4) During the operation, the tumor position was confirmed to be located in the antrum of the stomach by nanocarbon injection or gastroscope; (5) Complete laparoscopic radical gastrectomy for distal gastrectomy, and the gastrointestinal reconstruction was performed by delta-shaped anastomosis or overlap anastomosis. And the following exclusion criteria were applied: (1) History of gastric surgery; (2) Patients who cannot tolerate laparoscopic surgery because of comorbidities. Finally, data on 43 consecutive patients who underwent TLDG with Billroth-I reconstruction between January 2016 and November 2018 in Peking Union Medical College Hospital were retrospectively reviewed. Patients were divided into those who underwent Billroth-I reconstruction using an overlap method (n=20) or using delta-shaped anastomosis (n=23). The demographic and clinical characteristics and perioperative data of the two groups were analyzed. Measurement data that conformed to the normal distribution were expressed as the mean ± s, and differences between groups were compared using Student's t-test; comparisons between the counting data groups were performed using the χ(2) test or the continuously corrected χ(2) test. Results: The demographic and clinical characteristics were similar between the delta-shaped group and the overlap group (P>0.05). There was no significant difference between groups regarding operation time [(185.9±22.8) minutes vs. (184.0±25.8) minutes, t=0.260, P=0.796], blood loss [(50.9±36.0) ml vs. (47.0±30.8) ml, t=0.375, P=0.709], number of stapler reloads used for anastomosis (5.1±0.3 vs. 5.2±0.6, t=-0.465, P=0.651), time to flatus [(3.3±0.9) days vs. (3.6±0.9) days, t=-1.067, P=0.292) and postoperative hospitalization [(8.8±3.1) days vs. (10.4±3.8) days,t=-1.494, P=0.143]. As for the delta-shaped group and the overlap group, the anastomotic leakage rate was 4.3% (1/23) and 0 (χ(2)=0.000, P=1.000), respectively. The incidence of anastomotic bleeding was 4.3% (1/23) and 5.0% (1/20) (χ(2)=0.000, P=1.000), while the incidence of intra-abdominal hemorrhage was 4.3% (1/23) and 0 (χ(2)=0.000, P=1.000). The incidence of gastric emptying disorders was 4.3% (1/23) and 30.0% (6/20), respectively (χ(2)=3.454, P=0.063). All complications were cured after conservative treatment or symptomatic treatment. Conclusion: The overlap method for Billroth-I reconstruction is safe and feasible. 目的： 通过比较完全腹腔镜远端胃癌根治术（TLDG）中三角吻合与Overlap吻合两种BillrothⅠ式吻合方式的短期临床疗效，探讨Overlap胃-十二指肠吻合在TLDG术中的应用价值。 方法： 采用回顾性队列研究的方法。病例纳入标准：（1）术前经胃镜和胃三维重建，定位肿瘤位于胃窦部，病理活检提示为腺癌；（2）胸腹盆增强CT提示无肝、肺等远处转移；（3）术前经胃重建CT或超声内镜提示肿瘤临床分期为Ⅰ~Ⅲ期；（4）术中经纳米碳定位或胃镜再次确认肿瘤位于胃窦部；（5）行完全腹腔镜下远端胃癌根治术，采取三角吻合或Overlap吻合进行消化道重建。排除标准：（1）胃部手术史；（2）合并全身疾病不耐受腹腔镜手术。根据以上标准，收集北京协和医院2016年1月至2018年11月期间行TLDG的43例患者临床资料。其中23例采用三角吻合（三角吻合组），20例采用Overlap吻合（Overlap组），分析两组患者基本资料及围手术期相关指标。符合正态分布的计量资料以x±s表示，采用独立样本t检验比较；计数资料组间比较采用χ(2)检验或连续校正的χ(2)检验。 结果： 三角吻合组与Overlap组患者基线资料指标差异均无统计学意义（均P>0.05）。三角吻合组与Overlap组手术时间[（185.9±22.8）min比（184.0±25.8）min，t=0.260，P=0.796]、术中出血量[（50.9±36.0）ml比（47.0±30.8）ml，t=0.375，P=0.709]、术中消化道闭合及吻合使用钉仓数量[（5.1±0.3）枚比（5.2±0.6）枚，t=-0.465，P=0.651]、术后恢复排气时间[（3.3±0.9）d比（3.6±0.9）d，t=-1.067，P=0.292]以及术后住院时间[（8.8±3.1）d比（10.4±3.8）d，t=-1.494，P=0.143]的比较，差异均无统计学意义。三角吻合组与Overlap组术后围手术期并发症发生率比较，吻合口漏发生率分别为4.3%（1/23）和0（χ(2)=0.000，P=1.000），吻合口出血发生率分别为4.3%（1/23）和5.0%（1/20）（χ(2)=0.000，P=1.000），腹腔内出血发生率分别为4.3%（1/23）和0（χ(2)=0.000，P=1.000），胃排空障碍发生率分别为4.3%（1/23）和30.0%（6/20）（χ(2)=3.454，P=0.063）。均经保守治疗或对症处理后恢复。 结论： Overlap胃-十二指肠吻合在完全腹腔镜远端胃癌根治术消化道重建术中安全可行。.

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