근치적 위아전절제술 후 무봉합 위십이지장 문합술
Sutureless Gastroduodenostomy after Radical Subtotal Gastrectomy
김진영, 이종인, 정진호,
소속 상세정보
김진영 ( Kim Jin-Young )
관동대학교 의과대학 명지병원 외과
이종인 ( Lee Jong-In )
관동대학교 의과대학 명지병원 외과
정진호 ( Jeong Jin-Ho )
관동대학교 의과대학 명지병원 외과
KMID : 0371320020630010046
Abstract
Purpose: A gastroduodenostomy (Billroth I) is the most physiologic reconstructive method available today, it has recently been used more frequently subsequent to radical subtotal gastrectomies for the treatment of gastric cancers. However,
it is
inevitable that gastroduodenostomies involving sutures or staples may have complications such as ulcers, bleeding, or constriction caused by remaining foreign materials. We analyzed the results of sutureless gastroduodenostomies using
biofragmentable
anastomosis rings (BAR) with regard to safety, usefulness and profits.
Methods: Sutureless gastroduodenostomies using BAR (Valtrac, Davis & Geck Wayne, NJ) composed of polyglycolic acid and Barium for x-ray visualization, performed after radical subtotal gastrectomies in 17 gastric cancer patients in the period
from
1999 to 2001.
Results: Five patients had early cancers and 12 had advanced cancers. The mean size of the tumor masses was 5.0×3.7 ㎝, and the mean lengths of the proximal and distal resection margins from the tumors were 7.6 ㎝ and 3.0 ㎝ respectively.
The
lengths of lesser curvature and greater curvature of the resection specimens were 10.6 ㎝ and 20.5 ㎝ respectively. Fourteen tumors were located in the antrum and the other 3 were located in the body. The mean operating time was 164.4±35.2 min.,
and
the mean hospital stay was 14.1±3.1 days. Sips of water could be started 4.4±0.5 days after the operation. In all patients, the sutureless gastroduodenostomy site appeared watertight and maintained its initial burst strength, which was verified
using
gastrografin x-ray visualization performed 1 week after the operation. There were no anastomosis related complications in any of the patients; except for two mild satiety, which were treated quickly by the patients themselves. The BAR began to
fragment
3 weeks after the operation, and disappeared completely within 4 weeks. The diameters of the anastomosis sites were large enough to pass foods without constriction and no other secondary changes developed in the Barium x-ray visualization or
endoscopic
examination, which was performed 1 month after the operation.
Conclusion: A sutureless gastroduodenostomy using BAR is a safe, easy, and efficient reconstructive method to be used subsequent to a radical subtotal gastrectomy for gastric cancers.
키워드
위암; 위십이지장 문합술; 생분해성 문합고리; Gastric cancers; Gastroduodenostomy; Biofragmentable anastomosis ring;
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