OrVil经口抵钉座置入在腹腔镜食管-空肠(残胃)吻合的应用

Application of transorally inserted OrVil in esophagojejunostomy or esophagogastrostomy after totally laparoscopic total or proximal gastrectomy for proximal gastric cancer

目的对比腹腔镜辅助胃切除后食管-空肠(残胃)吻合,探究完全腹腔镜全胃或近端胃切除后使用经口抵钉座置入OrVil装置行食管-空肠(残胃)吻合的可行性及安全性。方法 2010年1月至2011年12月,10例近端胃癌行完全腹腔镜全胃或近端胃切除后使用经口抵钉座置入OrVil装置行食管-空肠(残胃)吻合,15例近端胃癌行腹腔镜辅助全胃或近端胃切除后食管-空肠(残胃)吻合,比较两组患者手术情况及吻合相关并发症。结果所有病例手术顺利,无中转开腹。两组患者手术时间、术中出血量、术后住院日比较无显著性差异(P>0.05)。完全腹腔镜手术组食管-空肠(残胃)吻合时间为(25.80±6.86)min,小于腹腔镜辅助手术组(36.53±6.63)min,差异有统计学意义(P<0.01)。完全腹腔镜手术组发生1例吻合口瘘,腹腔镜辅助手术组发生1例吻合口瘘、1例吻合口狭窄,两组患者吻合相关并发症比较,差异无统计学意义。结论完全腹腔镜经口抵钉座置入OrVil装置行食管-空肠(残胃)吻合安全、可行,操作简单,缩短吻合时间,并不增加吻合相关并发症的发生。

Objective To investigate the feasibility , safety and clinical outcomes of totally laparoscopic esophagojejunostomy or esophagogastrostomy using transorally inserted anvil (OrVil) after total or proximal gastrectomy for proximal gastric cancer. Methods From Janurary 2010 to December 2011, 10 patients underwent totally laparoscopic esophagojejunostomy or esophagogastrostomy using transorally inserted anvil (OrVil) while 15 patients underwent laparoscopy-assisted esophagojejunostomy or esophagogastrostomy after total or proximal gastrectomy for proximal gastric cancer in our hospital. The operating time, intra-operative blood loss , esophagojejunostomy or esophagogastrostomy time , post-operative hospital stay and anastomosis-related complications were compared between the two groups. Results All operations were performed successfully without conversion to open surgery. There were no significant differences in operating time, blood loss and post-operative hospital stay between the two groups (P >0.05). The esophagojejunostomy time was (25.80 ±6.86)min in the totally laparoscopic group, significantly shorter than (36.53±6.63)min in the laparoscopy-assisted group (P<0.01). There was no significant difference in anastomosis-related complications including fistula and stricture between the two groups (P>0.05). Conclusion Totally laparoscopic esophagojejunostomy or esophagogastrostomy using transorally inserted anvil (OrVil) after total or proximal gastrectomy for proximal gastric cancer is feasible and safe with simple procedures and anastomosis time shortened , which doesn’t increase anastomosis-related complications.