一种新型的完全腹腔镜下胃癌D2根治术后消化道重建方式

A new type of digestive tract reconstruction after totally laparoscopic gastrectomy with D2 lymphadennectomy for gastric cancer

目的探讨一种新型的完全腹腔镜下食管-空肠消化道重建方式在胃癌根治术中的应用。方法常规腹腔镜下淋巴结清扫并完全游离食管后,于远端食管近食管胃交界处用超声刀打开一长约2.5cm的小孔,置入一次性吻合器底钉座,用切割缝合型闭合器切断并闭合食管。在距离Treitz韧带15cm处分离并离断空肠,远端空肠提至食管底钉座处,在空肠远端食管置入吻合器,行食管空肠吻合。再用直线切割闭合器闭合远端空肠断端,并加强缝合食管与空肠之间的吻合口。最后,空肠近端断端与距离食管-空肠吻合口处以下55cm处的空肠行空肠-空肠端侧吻合。结果患者成功实施完全腹腔下胃癌根治术,术后未发生并发症或中转开腹,手术时间230min,出血150ml,术后无反流、吻合口漏、吻合口狭窄等严重并发症发生,患者恢复良好。结论完全腹腔镜下新型的消化道重建方式安全可行。

Objective To investigate a new type of digestive tract reconstruction after totally laparoscopic gastrectomy with D2 lymphadennectomy for gastric cancer. Methods After laparoscopic lymph node dissection and completely isolating the esophagus, open a small hole about 2.5 cm long by scalpel near the junction of stomach and the distal esophagus, put in a seat of stapler, Endo-GIA stapler was used to cut and close the esophagus, cut the jejunum at the distance of 15 cm from Treitz ligament, raised the distal jejunum to the seat of stapler, put a stapler into the distal esophagus, a esophageal-jejunum anastomosis was preformed, then we used a liner stapler to close the stump of distal jejunum, and sutured the anastomosis between the esophagus and jejunum. Finally, a side-to-side jejunojejunostomy was performed by placing the proximal portion of jejunfim to 55 cm away from the anastomosis. Results The patient underwent totally laparoscopic gastrectomy with D2 lymphadennectomy for gastric cancer without complications during the operation and turning to open surgery. Operation time and blood volume were 230 minutes and 150 ml respectively. Conclusions The new type of digestive tract reconstruction after totally laparoscopic gastrectomy for gastric cancer is safe and feasible.