Journal of Gastric Cancer

  • 제9권2호
  • /
  • Pages.57-62
  • /
  • 2009
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  • 2093-582X(pISSN)
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  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
권호 표지

원형 봉합기를 이용한 위십이지장연결술 시 단측연결과 단단연결의 비교

Comparison of End-to-side and End-to-end Anastomosis in Circular Stapled Gastroduodenostomy

  • 서민우 (순천향대학교 의과대학 외과학교실) ;
  • 김용진 (순천향대학교 의과대학 외과학교실) ;
  • 송단 (순천향대학교 의과대학 외과학교실) ;
  • 강길호 (순천향대학교 의과대학 외과학교실) ;
  • 조규석 (순천향대학교 의과대학 외과학교실) ;
  • 이문수 (순천향대학교 의과대학 외과학교실) ;
  • 허경열 (순천향대학교 의과대학 외과학교실) ;
  • 김재준 (순천향대학교 의과대학 외과학교실)
  • Seo, Min-Woo (Department of Surgery, Soonchunhyang University School of Medicine) ;
  • Kim, Yong-Jin (Department of Surgery, Soonchunhyang University School of Medicine) ;
  • Song, Dan (Department of Surgery, Soonchunhyang University School of Medicine) ;
  • Kang, Gil-Ho (Department of Surgery, Soonchunhyang University School of Medicine) ;
  • Cho, Gyu-Seok (Department of Surgery, Soonchunhyang University School of Medicine) ;
  • Lee, Moon-Soo (Department of Surgery, Soonchunhyang University School of Medicine) ;
  • Hur, Kyung-Yul (Department of Surgery, Soonchunhyang University School of Medicine) ;
  • Kim, Jae-Joon (Department of Surgery, Soonchunhyang University School of Medicine)
  • 발행 : 2009.06.30
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초록

목적: 원형 봉합기를 이용한 위십이지장연결술의 가장 대표적인 두 가지 방법(단측연결과 단단연결)의 수술 후 결과를 토대로 그 장단점을 확인하고자 본 연구를 고안하였다. 대상 및 방법: 2005년 3월부터 2008년 2월까지 순천향 대학병원에서 위암 진단 하 위십이지장 연결술을 시행한 134명을 대상으로 하였다. 2005년 3월부터 2006년 9월까지는 연속적으로 단측연결을(단측군, 76명), 2006년 11월부터 2008년 2월까지는 연속적으로 단단연결을 시행했다(단단군, 58명). 두 군을 대상으로 전향적 자료 수집을 통해 수술후 경과를 비교 분석하였다. 결과: 두 근간 모든 임상병리학적 요인에 차이가 없었다. 평균 수술시간은 단측군이 157분($\pm56$), 단단군이 150분($\pm49$)이었으며, 입원기간의 경우 단측군이 10.5일($\pm3.5$), 단단군이 9.4일($\pm2.9$)로 이 역시 두 군간에 차이는 없었다. 합병증과 관련해서 전체적으로 단측군이 15예(19.7%), 단단군은 8예(13.8%)에서 발생하였으며(P=0.489), 연결부위 관련해서 단측군에서 출혈이 2예 및 협착이 2예 있었으며, 단단군의 경우 출혈이 2예에서 있었다(P=0.698). 결론: 원형 봉합기를 이용한 위십이지장연결술은 두 방법 모두 기술적으로 용이하며 안전하였다. 통계적 의의는 없었지만, 연결 부위 협착과 관련해서는 단측군에서만 2예 발생하여 단단군이 더 나은 경향을 보였다.

Purpose: The use of automatic circular staplers for gastroduodenostomy after distal gastrectomy is now widely accepted. We compared the clinical outcomes of two different methods. Materials and Methods: Between March 2005 and February 2008, 134 patients with gastric cancer underwent distal gastrectomies. Seventy-six consecutive patients received end-to-side gastroduodenostomies (ES) between March 2005 and September 2006. The remaining 58 consecutive patients received end-to-end gastroduodenostomies (EE) between November 2006 and February 2008. We analyzed the surgical outcomes between the two groups (ES versus EE) on the basis of prospectively collected data. Results: Among the clinical factors, there were no differences between the two groups. The overall complication rates were 19.7% in the ES group and 13.8% in the EE group (P=0.489). With respect to anastomosis-related complications, 2 cases had bleeding and 2 cases had stenoses in the ES group, while 2 cases in the EE group had bleeding. Re-operation was needed in the case of intraluminal bleeding in the ES group. There were no mortalities in our study. Conclusion: The two methods for gastroduodenostomy were safe and technically feasible. Although there was no statistical difference in the overall complications, including anastomosis-related complications, we demonstrated better outcomes with respect to anastomotic stenosis in the EE group.

키워드

참고문헌

  1. Seufert RM, Schmidt-Matthiesen A, Bayer A. Total gastrectomy and oesophagojejunostomy-a prospective randomized trial of hand-sutured versus mechanically stapled anastomoses. Br J Surg 1990;77:50-52. https://doi.org/10.1002/bjs.1800770118
  2. West of Scotland and Highland Anastomosis Study Group. Suturing or stapling in gastrointestinal surgery: a prospective randomized study. Br J Surg 1991;78:337-341. https://doi.org/10.1002/bjs.1800780322
  3. Nance FC. New techniques of gastrointestinal anastomoses with the EEA stapler. Ann Surg 1979;189:587-600. https://doi.org/10.1097/00000658-197905000-00008
  4. Takahashi T, Saikawa Y, Yoshida M, Otani Y, Kubota T, Kumai K, Kitajima M. Mechanical-stapled versus hand-sutured anastomoses in billroth-I reconstruction with distal gastrectomy. Surg Today 2007;37:122-126. https://doi.org/10.1007/s00595-006-3361-z
  5. Hori S, Ochiai T, Gunji Y, Hayashi H, Suzuki T. A prospective randomized trial of hand-sutured versus mechanically stapled anastomoses for gastroduodenostomy after distal gastrectomy. Gastric Cancer 2004;7:24-30. https://doi.org/10.1007/s10120-003-0263-2
  6. Nakane Y, Kanbara T, Michiura T, Inoue K, Iiyama H, Nakai K, Okumura S, Yamamichi K, Hioki K. Billroth I gastrectomy using a circular stapler to treat gastric cancer. Surg Today 2001;31:90-92. https://doi.org/10.1007/s005950170229
  7. Oka M, Maeda Y, Ueno T, Iizuka N, Abe T, Yamamoto K, Ogura Y, Masaki Y, Suzuki T. A hemi-double stapling method to create the Billroth-I anastomosis using a detachable device. J Am Coll Surg 1995;181:366-368.
  8. Yang HK, Information Committee of the Korean Gastric Cancer Association. Current status of clinical practice for gastric cancer patients in Korea. J Korean Castric Cancer Assoc 2004;4:95-108.
  9. Mittal VK, Cortez JA. New techniques of gastrointestinal anastomoses using the EEA stapler. Surgery 1980;88:715-718.
  10. Kuwabara Y, Shinoda N, Sato A, Kimura M, Ishiguro H, Sugiura H, Tanaka T, Ando T, Fujii Y, Fujii Y. Billroth I gastroduodenostomy using a hemi-double stapling technique. J Am Coll Surg 2004;198:670-672. https://doi.org/10.1016/j.jamcollsurg.2003.11.016
  11. Takeuchi K, Tsuzuki Y, Ando T, Sekihara M, Hara T, Kori T, Nikajima H, Kuwano H. A modified stapling technique for performing Billroth I anastomosis after distal gastrectomy. World J Surg 2005;29:113-115. https://doi.org/10.1007/s00268-004-7356-x
  12. Yang HK, Lee HJ, Ahn HS, Yoo MW, Lee IK, Lee KU. Safety of modified double-stapling end-to-end gastroduodenostomy in distal subtotal gastrectomy. J Surg Oncol 2007;96:624-629. https://doi.org/10.1002/jso.20883
  13. Lee MS, Kang GH, Cho GS, Kim YJ, Kim HS, Lee HS, Kim SY, Baek MJ, Kim CH, Cho MS. Circular stapled billroth i anastomosis after distal subtotal gastrectomy - anastomotic complications and prevention. J Korean Gastric Cancer Assoc 2006;6:103-108. https://doi.org/10.5230/jkgca.2006.6.2.103
  14. Zilling T, Walther BS. Are intersecting staple lines a hazard in intestinal anastomosis? Dis Colon Rectum 1992;35:892-896. https://doi.org/10.1007/BF02047879
  15. Griffen FD, Knight CD Sr, Whitaker JM, Knight CD Jr. The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg 1990;211:745-751. https://doi.org/10.1097/00000658-199006000-00014
  16. Redmond HP, Austin OM, Clery AP, Deasy JM. Safety of doublestapled anastomosis in low anterior resection. Br J Surg 1993;80:924-927. https://doi.org/10.1002/bjs.1800800746