经口置入钉砧头系统(OrVil)在全腔镜下食管癌根治术中消化道重建中的应用体会

Transorally Inserted Anvil (OrVil) for Digestive Tract Reconstruction Technique during Total Thoracoscopic and Laparoscopic Esophagectomy

目的总结经口置入钉砧头系统(OrVil)在全腔镜食管癌根治术中消化道重建中的应用经验。方法 2010年1月～4月,利用OrVil行完全腔镜下食管癌根治手术5例。男3例,女2例,平均年龄67岁(58～76岁)。肿瘤位于食管中段1例、食管下段3例、贲门1例。肿瘤平均长度4.3cm(1.5～5cm)。先腹腔镜游离胃、制作管状胃,清扫腹腔淋巴结,然后胸腔镜游离胸段食管,清扫胸部淋巴结,镜下行食管胃端侧吻合术。结果 5例均在完全腔镜下完成手术,手术顺利,无中转开胸及开腹,无死亡及严重并发症发生。平均手术时间260min(210～300min),平均出血量352ml(120～450ml)。术后5～7天内进食流质饮食,平均住院时间20d(14～26d)。随访30～100d,无吻合口并发症。结论 OrVil在全腔镜下食管癌根治术消化道重建中可以快速、便捷、有效地替代常规放置钉砧头和荷包制作,是一种安全可靠的全腔镜下消化道重建辅助系统。

Objective To summarize our experience on digestive tract reconstruction by using the transorally inserted anvil（OrVil,Covidien）in total thoracoscopic and laparoscopic esophagectomy,and to evaluate its feasibility and safety.MethodsBetween January 2010 and April 2010,5 patients（3 men and 2 women,mean age 67.0 years,ranging from 58 to 76 years）,underwent total thoracoscopic and laparoscopic esophagectomy with OrVil in our hospital.In the patients,the tumor was located at the middle esophagus in one case,the lower esophagus in 3 cases,and at the cardia orifice in the other.The mean length of the tumor was 4.3 cm（ranged from 1.5 to 5 cm）.During the operation,we separated the stomach under a laparoscope to form a tube,and then,after removing intra-abdominal lymph nodes,we separated the thoracic esophagus,and resected thoracic lymph nodes.Finally,esophagus-stomach anastomosis was perfomed.Results All the procedures were carried out smoothly without converting to open surgery,or leading to serious complications nor death.The mean operation time in this series was 260 minutes（ranged from 210 to 300 minutes）.The mean intraoperative blood loss was 352 ml（120-450 ml）.All the patients received liquid diet in 5 to 7 days after the operation.The mean hospital stay was 20 days（ranged from 14 to 26 days）.The patients were followed up for 30 to 100 days,during which no anastomotic complications occurred.Conclusion OrVil system is safe and effective for digestive tract reconstruction in total thoracoscopic and laparoscopic esophagectomy.