胃次全切除后圆形吻合器完成残胃-空肠端侧吻合的实验与临床应用研究

目的探讨胃次全切除后采用圆形吻合器行残胃．空肠端侧吻合的实验与临床可行性。方法Beagle＇s犬12条，随机分成A、B两组，在胃窦切除后分别以器械或手工行残胃-十二指肠端侧吻合术。3个月后，以器械行残胃-十二指肠侧侧吻合术。测量残胃十二指肠侧侧吻合处及邻近的十二指肠周长；并观察残胃空肠端侧吻合口直径及愈合情况。选择163例远端胃癌患者，随机分成C、D两组，C组89例，D组74例。胃次全切除后，分别以器械或手工行残胃-空肠端侧吻合术，手术后观察吻合口漏、狭窄等并发症，1年后行稀钡上消化道造影，观察吻合口钡剂通过和2h后残胃钡剂残留情况。结果手术后12条Beagle＇s犬术后均恢复良好，残胃十二指肠侧侧吻合处及邻近的十二指肠周长分别是（6．46±0．06）cm，（7．26±0．12）cm。残胃空肠端侧吻合口及小弯侧三角处愈合均良好，A、B两组吻合口直径分别为（1．18±0．13）cm和（1．20±0．09）cm。两组比较差异无显著性意义（t=0．255，P=0．804）。163例患者均顺利完成手术，术后未出现吻合口漏、狭窄等并发症，术后1年，2组分别行上消化道稀钡造影，均显示吻合口无明显狭窄，钡剂通过顺利，2h后残胃仅见少量钡剂残留。结论胃次全切除后应用器械行残胃-空肠端侧吻合能够在残胃的原位完成消化道重建，降低吻合难度，方法可行。

Clinical and experimental study of end-to-side gastrojejunostomy with circular stapler after distal subtotal gastrectomy

Objective To study the clinical and experimental effects of end-to-side gastrojejunostomy with circular stapler after distal subtotal gastrectomy. Methods Twelve Beagle's dogs were randomly divided into groups A and B. End-to-side gastroduodenostomy was done with circular staplers or hand-sewing after gastrectomy. Side-to-side gastroduodenostomy was done in the second operation after three months. Healing and diameter of end-to-side gastroduodenostomy were observed in Beagle'sdogs, and the perimeters of side-to-side gastroduodenostomy and the duodenum adjacent to anastomosis were measured. 163 patients who had suffered from stomach cancer were randomly divided into group C, 89 cases,and group D,74 cases. End-to-side gastrojejunostomy was performed with circular stapler or hand-sewing after distal subtotal gastrectomy. Leakage and stricture of anastomosis were observed after operation. Size of anastomosis and track of barium fluid and gastric residual barium fluids in two hours were observed half a year after operation. Results All operations in 12 dogs were successful. Healing of anastomoses and triangles at the small curvature were satisfactory three months after operation. The diameter of end-to-side gastroduodenostomy in groups A and B was (1.18±0.13) cm and (1.20±0.09) cm respectively. There was no significant difference between the two groups (t=0.255,P=0.804). Circumferences of side-to-side gastroduodenostomy and duodenum adjacent to anastomosis were (6.46±0.06) cm, (7.26±0.12) cm respectively. All operations on 106 patients were successful and no complications of leak and stricture of anastomosis occurred. Thin barium fluid passed over anastomosis quickly in X-ray after half a year. There was a little barium fluid in the residual stomach in two hours. Conclusion End-to-side gastrojejunostomy with circular stapler after distal subtotal gastrectomy is feasible. Anastomosis at the original position of residual stomach ensures adequate removal of the stomach, prevents trauma from the spleen and surrounding vessels, and decreases difficulty in anastomosis.