一种勿需缝合的完全腹腔镜胃肠毕Ⅱ式吻合技术

Totally laparoscopic Billroth II gastrectomy without intracorporeal hand-sewn sutures

目的探讨一种新的勿需缝合的完全腹腔镜下胃肠毕Ⅱ式吻合技术的安全性和可行性。方法2011年5．7月间第四军医大学西京消化病医院采用自行设计的吻合技术完成完全腹腔镜胃癌D2根治术12例。该术式采用环形吻合器行胃空肠吻合，再用切割闭合器于肠壁开口处行空肠输入袢或输出袢侧侧吻合，最后关闭肠壁开口。结果12例完全腹腔镜胃大部切除术均获成功，无中转开腹或中转腹腔镜辅助手术；手术时间（196．O±19．3）min，术中出血量（169．5±28．8）ml。切除淋巴结（25．1±3．3）枚，近端切缘和远端切缘分别为（8．8±2．4）cm和（6．9±5．5）cm。术后首次排气时间平均为（3．1±1．3）d，术后住院时间（4．5±1．9）d，住院期间内均未观察到明显并发症。结论该吻合技术操作简单、快捷，勿需镜下手工缝合．用于完全腹腔镜胃大部切除重建手术安全、可行。

Objective To evaluate the safety and feasibility of a novel totally laparoscopic Billroth II gastrectomy. Methods Twelve gastric cancer patients underwent totally laparoscopic D2 dissection without intracorporeal hand-sewn sutures in the Xijing Hospital of Fourth Military Medical University between May 2011 and July 2011. In this technique, circular stapling device was used for gastrojejunostomy, and an Endo GIA was used to close the incision at the greater curvature of the stomach. After the completion of the anastomosis, a side-to-side anastomosis （jejunum-afferent loop or jejunum-efferent loop） was performed using an Endo-GIA. Results No patients required conversion to laparoscopy-assisted or open surgery. The operative time was 196.0±19.3 min, and the blood loss was 169.5±28.8 ml. The number of lymph node harvested was 25.1±3.3. The proximal resection margin and distal resection margin were 8.8±2.4 cm and 6.9±5.5 cm, respectively. The mean time to the first postoperative flatus was 3.1±1.3 days. The length of hospital stay was 4.5±1.9 days. Conclusion This technique is simple and quick. There is no need for laparoscopic hand-sewn suturing. It is safe to perform for totally laparoscopic gastrectomy and reconstruction.