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目的比较机器人系统行胃癌全胃切除术中采用可吸收线连续缝合与免打结自固定缝线连续缝合两种镜下吻合方法的安全性、可行性及难易程度。方法回顾性分析南京军区南京总医院2012年4月至2015年4月由同一术者实施达芬奇手术机器人胃癌全胃切除、全镜下消化道重建57例病人临床资料。按吻合方式分为可吸收线连续缝合组(A组,n=35)和免打结自固定缝线连续缝合组(B组,n=22)。分别比较两组的手术时间、吻合时间、住院时间以及术后并发症发生率,并由手术医师评估吻合的技术难度。结果 57例病人均完成手术,无一例中转开腹。A组总手术时间(251.3±64.4)min,食管空肠吻合时间(37.8±11.6)min,空肠空肠吻合时间(29.4±8.7)min,术后住院(5.5±3.7)d,术后发生吻合相关并发症共2例;B组总手术时间(192.8±52.9)min,食管空肠吻合时间(18.1±7.9)min,空肠空肠吻合时间(14.6±6.3)min,均比A组明显缩短(P<0.05),术后住院(4.7±4.1)d,少于A组(P<0.05),术后未发生吻合相关并发症,与A组相比有所下降(2/35 vs.0/22)。经术者主观评估,B组的吻合技术难度低于A组,经第一助手主观评估,B组的配合难度也低于A组。结论在机器人全胃切除术中两种吻合方法均安全、可行,免打结自固定缝线法降低了吻合的难度,明显缩短了吻合时间及总手术时间,并能减少病人术后的住院时间。
Objective To compare the safety, feasibility and difficulty of two kinds of microsurgical anastomosis methods using robotic system for gastric cancer gastrectomy with continuous absorbable suture and continuous suture without suture self-fixating suture. Methods A retrospective analysis of Nanjing General Hospital of Nanjing Military Region from April 2012 to April 2015 by the same surgeon implementation Da Vinci surgical gastrectomy of gastric cancer patients undergoing total gastrointestinal reconstitution 57 cases of clinical data. According to the anastomosis, there were continuous suture group (group A, n = 35) and continuous suture group (group B, n = 22) without suture. The operation time, anastomosis time, hospitalization time and the incidence of postoperative complications were compared between the two groups, and the technical difficulty of anastomosis was evaluated by the surgeon. Results 57 patients completed the operation, no case of conversion to open surgery. In group A, the total operative time (251.3 ± 64.4) min, esophageal and jejunal anastomosis time (37.8 ± 11.6) min, jejunum jejunum anastomosis time (29.4 ± 8.7) min, postoperative hospitalization (5.5 ± 3.7) d, postoperative anastomosis related complications (P <0.05). The total operative time in group B was (192.8 ± 52.9) min, the time of esophageal and jejunostomy was (18.1 ± 7.9) min and the time of jejunum jejunum was (14.6 ± 6.3) min, , Postoperative hospital stay (4.7 ± 4.1) d, less than that in group A (P <0.05). There was no postoperative complications related to anastomosis, which was lower than that in group A (2/35 vs.0 / 22). Subjective assessment by the surgeon, B group of anastomosis technical difficulty is lower than A group, subjective assessment by the first assistant, B group with less difficulty than the A group. Conclusion Both methods of anastomosis in total gastrectomy are safe and feasible. The self-fixating suture-free knotting method reduces the difficulty of anastomosis, significantly shortens the time of the anastomosis and the total operation time, and can reduce the postoperative hospital stay .