经口腔置入钉砧头行腹腔镜下胃转流手术

Laparoscopic gastric bypass surgery by anvil going through mouth on type 2 diabetes patients

目的探讨经口腔置入钉砧头(OrVilTM,Covidien,USA)行腹腔镜下胃空肠体内圆形吻合在胃肠吻合方法中的意义。方法常规建立气腹,充分游离胃大弯侧和胃小弯侧后,用切割缝合器将其离断,经口腔使用OrVilTM系统将钉砧头置入胃腔。然后在腹部正中线做4cm小切口,通过该切口行空肠空肠吻合,形成一定长度的空肠支后,将圆形吻合器置入空肠中然后导入腹腔,在体内完成胃空肠吻合。术前和术后1个月检查口服葡萄糖耐量试验、胰岛素释放试验、C-肽释放试验、糖化血红蛋白和体重指数。结果 15例2型糖尿病患者成功实施腹腔镜下GBP,术中未发生并发症或中转开腹。平均手术时间为105min,出血量为110ml。结论成功采用经口腔置入钉砧头完成腹腔镜下GBP,可明显改善2型糖尿病患者的糖代谢。

Objective To introduce a new technique of laparoscopic gastric bypass surgery by anvil going through mouth on type 2 diabetes patients （ T2DM ）. Methods After isolating the omentum along the lesser and greater curvature of the stomach, Endo-GIA stapler was used to cut the stomach. OrVilTM went through the mouth to the end of stomach. Then a 4cm upper midline incision was made, a side-to-side jejunojejunostomy is performed by placing the proximal portion of jejunum to lower part of jejunum and a side-to-side gastrojejunostomy was created by Circular stapler. Oral glucose tolerance test, insulin release test, C peptide release test, HbA1C, body mess index were evaluated before surgery and lmonths after surgery. Results Fifteen diabetes patients underwent laparoscopic gastric bypass without complication during the operations and turning to open surgery. Average operation time and blood volume were 105 minutes and 110ml respectively. Comparing with fasting blood glucose （ FBG ） and HbAlc before surgery, they dropped significantly 1 months after the surgery. Conclusions Laparoscopic GBP was underwent by OrVilTM going through mouth resulted in the resolution of T2DM.