Application of two “half pocket” suture embedding method to strengthen duodenal stump in radical gastrectomy

doi:10.3877/cma.j.issn.1674-3946.2023.04.011

Abstract

Abstract:

Objective

To investigate the effect of two “half pocket” suture embedding method in strengthening duodenal stump during radical gastrectomy of gastric cancer.

Methods

The clinical data of 194 patients with gastric cancer who underwent radical gastrectomy from December 2018 to March 2021 were retrospectively analyzed. According to different methods of strengthening duodenal stump during the operation，two “half-bag” suture embedding method were used in the observation group（110 cases），and sarcomuscular suture embedding method was used in the control group（84 cases）. SPSS 25.0 software was used for statistical analysis，and the perioperative indicators（

x ¯

±s）of the two groups were compared by independent sample t test，and postoperative complications（%）were compared by χ² test. P < 0.05 was considered to be statistically significant.

Results

None of the patients died. The incidence of duodenal stump leakage in the observation group was significantly lower than that in the control group（0% vs. 3.6%， P = 0.046）. The ratio of duodenal stump length ≤0.5 cm in observation group was significantly higher than that in control group（27.3% vs. 13.1%，P = 0.016）. Duodenal embedding time in the observation group was significantly shorter than that in the control group［（2.5 ± 0.8）vs.（4.7 ± 0.9）min，P < 0.001］.

Conclusion

The occurrence of duodenal stump leakage can be significantly reduced by using two “half pocket” suture embedding method to strengthen duodenal stump during radical gastrectomy. The embedding time of the method is short，the operation is simple，and the embedding difficulty caused by the short duodenal stump can be solved. Therefore，this method is worth popularizing and applying in gastric cancer surgery.

Key words: Stomach Neoplasms, Duodenal Stump Leak, Gastrectomy

Tianming Xia, Zhen Xu, Yunshuai Wang, Chaohui Li, Baowei Han. Application of two “half pocket” suture embedding method to strengthen duodenal stump in radical gastrectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(04): 389-392.

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References 16

[1]	Smyth EC，Nilsson M，Grabsch HI，et al. Gastric cancer［J］. Lancet，2020，396（10251）：635-648.
[2]	Johnston FM，Beckman M. Updates on Management of Gastric Cancer［J］. Curr Oncol Rep，2019，21（8）：67.
[3]	陈凛，鲁意迅，张珂诚. 中国腹腔镜胃癌根治术式选择与规范化［J/CD］. 中华普外科手术学杂志（电子版），2022，16（03）：242-245.
[4]	Patricia YPC，Kevin WKF，Yee LF，et al. Duodenal stump leakage. Lessons to learn from a large-scale 15-year cohort study［J］. Am J Surg，2020，220（4）：976-981.
[5]	Gu L，Zhang K，Shen Z，et al. Risk Factors for Duodenal Stump Leakage after Laparoscopic Gastrectomy for Gastric Cancer［J］. J Gastric Cancer，2020，20（1）：81-94.
[6]	Ri M，Hiki N，Ishizuka N，et al. Duodenal stump reinforcement might reduce both incidence and severity of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer［J］. Gastric Cancer，2019，22（5）：1053-1059.
[7]	He H，Li H，Ye B，et al. Single Purse-String Suture for Reinforcement of Duodenal Stump During Laparoscopic Radical Gastrectomy for Gastric Cancer［J］. Front Oncol，2019，9：1020.
[8]	李剑，韩广森，徐勇超，等. “Ｔ”形缝合包埋预防远端胃癌根治术后十二指肠残端瘘［J］. 中华胃肠外科杂志，2012，15（02）：187.
[9]	刘英俊，王刚成，刘晓勇，等. 带蒂肝圆韧带预防胃癌术后十二指肠残端瘘的疗效［J］. 中华普通外科杂志，2018，33（04）：273-275.
[10]	尚闯，龚哲，高阳，等. 十二指肠浆肌层与胰腺组织缝合包埋预防胃癌根治术后十二指肠残端瘘［J］. 医药论坛杂志，2016，37（08）：176.
[11]	Zizzo M，Ugoletti L，Manzini L，et al. Management of duodenal stump fistula after gastrectomy for malignant disease：a systematic review of the literature［J］. BMC Surg，2019，19（1）：151.
[12]	邝满元，易西南，王岐本，等. 幽门及十二指肠上部的血供及其临床意义［J］. 中国临床解剖学杂志，2008，（04）：380-382.
[13]	熊建平，田艳涛. 腹腔镜胃癌根治术术后常见并发症的防治［J］. 腹腔镜外科杂志，2021，26（01）：13-15，31.
[14]	Kim MC，Kim SY，Kim KW. Laparoscopic Reinforcement Suture（LARS）on Staple Line of Duodenal Stump Using Barbed Suture in Laparoscopic Gastrectomy for Gastric Cancer：a Prospective Single Arm Phase II Study［J］. J Gastric Cancer，2017，17（4）：354-362.
[15]	Cozzaglio L，Cimino M，Mauri G，et al. Percutaneous transhepatic biliary drainage and occlusion balloon in the management of duodenal stump fistula［J］. J Gastrointest Surg，2011，15（11）：1977-1981.
[16]	Paik HJ，Lee SH，Choi CI，et al. Duodenal stump fistula after gastrectomy for gastric cancer：risk factors，prevention，and management［J］. Ann Surg Treat Res，2016，90（3）：157-163.

组别	例	年龄（岁）	性别	肿瘤部位
组别	例	年龄（岁）	男/女	a/b/c
观察组	110	64.4±10.1	87/23	39/29/42
对照组	84	65.6±9.1	67/17	31/20/33
t/χ²值 P值		-0.890 0.375	0.013 0.909	0.166 0.920
组别	例	肿瘤大小（cm）	临床分期
组别	例	肿瘤大小（cm）	Ⅰ-Ⅱ期/Ⅲ-Ⅳ期
观察组	110	5.1±2.6	47/63
对照组	84	4.6±2.3	38/46
t/χ²值 P值		1.372 0.172	0.122 0.727

组别	例	年龄（岁）	性别	肿瘤部位
组别	例	年龄（岁）	男/女	a/b/c
观察组	110	64.4±10.1	87/23	39/29/42
对照组	84	65.6±9.1	67/17	31/20/33
t/χ²值 P值		-0.890 0.375	0.013 0.909	0.166 0.920
组别	例	肿瘤大小（cm）	临床分期
组别	例	肿瘤大小（cm）	Ⅰ-Ⅱ期/Ⅲ-Ⅳ期
观察组	110	5.1±2.6	47/63
对照组	84	4.6±2.3	38/46
t/χ²值 P值		1.372 0.172	0.122 0.727

组别	例		手术入路		胃切除方式		十二指肠残端长度
组别	例		开腹/腔镜辅助		全胃/远端胃		>0.5 cm/≤0.5 cm
观察组	110		56/54		93/17		80/30
对照组	84		46/38		73/11		73/11
χ²值 P值			0.284 0.594		0.216 0.643		5.744 0.016
组别	例	十二指肠残端包埋时间(min)		手术时间 (min)		住院时间 (d)
观察组	110	2.5±0.8		284.9±83.8		14.6±4.5
对照组	84	4.7±0.9		287.7±83.7		15.3±5.4
t值 P值		-17.489 <0.001		-0.223 0.824		-0.968 0.322

组别	例		手术入路		胃切除方式		十二指肠残端长度
组别	例		开腹/腔镜辅助		全胃/远端胃		>0.5 cm/≤0.5 cm
观察组	110		56/54		93/17		80/30
对照组	84		46/38		73/11		73/11
χ²值 P值			0.284 0.594		0.216 0.643		5.744 0.016
组别	例	十二指肠残端包埋时间(min)		手术时间 (min)		住院时间 (d)
观察组	110	2.5±0.8		284.9±83.8		14.6±4.5
对照组	84	4.7±0.9		287.7±83.7		15.3±5.4
t值 P值		-17.489 <0.001		-0.223 0.824		-0.968 0.322

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