经口腔置入Orvil^(TM)在腹腔镜全胃切除食管空肠吻合术中的应用

Application of esophagojejunostomy using the transorally inserted anvil Orvil^(TM) after laparoscopic total gastrectomy

目的探讨经口腔置入OrvilTM在腹腔镜全胃切除(LTG)中食管空肠吻合术技术的可行性及临床疗效。方法 40例贲门癌、胃体癌患者被随机分为试验组(T组,20例)及对照组(C组,20例)。T组应用OrvilTM系统将钉钻头置入食道下端,C组采用传统荷包缝合法将钉钻头置入食道下端,两组均采用圆形吻合器通过双吻合技术在体内行食管-空肠吻合。对照分析两组平均手术时间、术中出血量、术后出血量、腹腔感染率、胃肠道功能恢复时间、住院时间、术后吻合口瘘、吻合口狭窄等并发症的发生情况。结果 T组平均手术时间[(180.0±30.2)min]略高于C组(173±25.6)min],但差异无统计学意义;术中出血量T组[(150±15)ml]与C组[(140±17)ml]比较差异无统计学意义;与C组比较,T组胃肠道功能恢复时间[(4.7±1.2)dvs.(3.5±0.5)d];平均住院时间[(11.7±1.2)dvs.(8.0±1.0)d]缩短,差异有统计学意义;两组患者均无术后出血、腹腔感染、吻合口瘘及吻合口狭窄等并发症的发生。结论经口腔置入OrvilTM在腹腔镜全胃切除(LTG)术中食管空肠吻合技术安全可靠,能明显缩短住院时间及胃肠道功能恢复时间,疗效良好。

Objective To introduce a new esophagojejunostomy using the transorally inserted anvil OrvilTM after Laparoscopic total gastrectomy, and investigate its technical feasibility and clinic therapeutic effects. Methods Forty inpatients suffered cardia or body gastric carcinoma were allocated into test group （group T, n = 20 ）and control group （group C, n = 20）. Laparoseopic total gastreetomy was performed in all inpatients. The anvil OrvilTM was transorally inserted into the inferior extremity of esophagus being liberated in group T, yet the anvil was purse-string suture traditionarily in group C. Double-stapling esophagojejunostomy with a circular stapler was performed intracorporeally, and contrast analysis of mean operation time, intraoperative blood loss, postoperative blood loss, intra-abdominal infection rate, postoperative resumed an oral liquid diet day, mean postoperative hospital day, postope- rative leakage and stenosis of the anastomosis was applied. Results All operations were successful without intraoperative complications or conversion to open surgery. The mean operation time of group T [ （ 180 ± 30.2）min] was longer than that in group C[ （ 173±25.6）min] slightly, and intraoperative blood loss in group T [（150 ± 15）ml] was no different from that in group C [（140 ＋ 17） ml]. The recovery time of gastrointestinal function in group T [（3.5 ± 0.5）d] was earlier than that in group C [（4.7 ± 1.2） d]. The mean postoperative hospital stay of group T was shorter than group C [ （8.0 ±1.0） d vs. （11.7± 1.2）, P 〈 0.01 ]. There were no postope- rative blood loss, intra-abdominal infection, postoperative leakage and stenosis in two groups. Conclusion The application of esophagojejunostomy using the transorally inserted anvil OrvilTM after laparoscopic total gastreetomy is secure and reliable, can shorten the length of hospital stay and recovery time of gastrointestinal function, and lead to stirring clinic therapeutic effects