幽門側胃切除後のBillroth I法再建における器械吻合の有用性

Abstract

To evaluate the usefulness of instrumental Billroth I anastomosis we used Proximate ILS for gastroduodenostomy after distal gastrectomy. We compared instrumen- tal anastomosis with handsewn anastomosis, operation time, blood loss, oral intake, meal intake, hospital stay after operation and complication. A questionnaire survey was conduct- ed for weight change, food intake, post operative gastrointestinal problem, physical condi- tion and satisfaction with the operation. From June 1994 to September 1996, 15 gastric cancer patients underwent instrumental Billroth I anastomosis. We compared these cases with 15 handsewn Billroth I patients operated on during the same period. Stomach is mobilized after lymph node cleaning. Stay suture is put on the resection line and, when the tumor is small, ILS is inserted through proximal cut end of the duodenum cut to pylorus ; when the tumor is large, gastrotomy is placed on the anterior wall proximal to the tumor to avoid the inplantation of the cancer cell, and ILS exits through the posterior wall of the stomach 1cm proximal to the resection line. ILS is fired with the anvil inserted in the duodenum. After that the stomach is resected with Nakayama's gastric sewing clamp. As for the background factors there was no difference between the two groups. Opera- tion time, oral intake and hospital stay after operation are significantly shorter in the group of instrumental anastomosis. As for the questionnaire survey, satisfaction with the opera- tion is significantly better in the instrumental group. Weight change and food intake are better in the instrumental group but not significantly so. We experienced no complications such as bleeding, stenosis and leakage after instrumental anastomosis. We conclude that this method is an easy and safe procedure.