胃癌全胃切除术应用管状吻合器和生物吻合环重建消化道的体会

Evaluation of the effect of anastomat and biofragmentable anastomosis ring in the reconstruction of alimentary tract after total gastrectomy

目的 介绍管状吻合器和生物吻合环在胃癌全胃切除术中消化道重建中的应用体会。方法 全胃切除术中用Roux -Y方式重建消化道 ,其中食管空肠吻合由吻合器完成 ,而空肠间端侧吻合由手工缝合或用可降解吻合环完成。结果 本组 5 6例食管空肠对端吻合及空肠端侧吻合均获一次性成功 ,无手术死亡 ,无吻合口漏。手术时间 90～ 3 10min ,平均 160min。用吻合环完成空肠端侧吻合者平均手术时间仅为 13 0min。术后 6～ 12个月随诊胃镜或钡餐检查 ,5 4例吻合口愈合良好 ,仅 2例出现吻合口狭窄 ,并通过气囊扩张后症状明显改善。结论 在全胃切除术消化道重建中 ,应用吻合器和吻合环作吻合有方便、快捷、可靠等优点 ,有利于防止吻合口漏等并发症。只要患者经济条件允许 ,尽量采用一次性吻合器和吻合环重建消化道。

Objective To evaluate the effect of application of anastomat and biofragmentable anastomosis ring(BAR) in the reconstruction of alimentary tract after total gastrectomy for gastric carcinoma.Methods Roux-Y type anastomosis was used in the reconstruction of alimentary tract after total gastrectomy for gastric carcinoma.Esophagojejunostomy was accomplished by anastomat,and jejunojejunostomy was accomplished by BAR.Results After total gastrectomy for gastric carcinoma,end-end esophagojejunostomy and end-side jejunojejunostomy were performed once successfully in 56 cases.There was no death or anastomotic leakage and so on after operation.Operative time was from 1.5 h to 5.2 h,average 2.7 h.Among them,those with BAR had an average operative time of 2.2 h only.After a follow-up of 6～12 months,gastroscopy or barium meal was performed.It was found that anastomotic stoma healed well in 54 cases,only 2 cases suffered from anastomotic stricture,whose symptom was improved obviously after gasbag expansionism.Conclusion In the reconstruction of alimentary tract after total gastrectomy,anastomat and BAR vs with traditional manual anastomosis,having some advantages,for example,convenient,shortcut,reliable etc,are helpful to prevent the complications after operation,for instance,anastomotic fistulas etc.