经口置入钉砧头系统(OrVilTM)在Siewert Ⅱ型食管胃结合部腺癌腹腔镜手术中的应用

Application of transorally inserted anvil （OrVilTM） in laparoscopic-assisted radical resection for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction

目的探讨经口置入钉砧头系统（OrVilTM）在SiewertⅡ型食管胃结合部腺癌腹腔镜手术中应用的安全性及可行性。方法回顾性分析2009年5月至2012年8月北京大学肿瘤医院胃肠肿瘤微创外科连续行腹腔镜辅助Siewert Ⅱ型食管胃结合部腺癌根治术的72例患者的临床资料，其中应用OrVilTM行消化道重建46例（OrVilTM组），应用传统荷包钳包埋圆形吻合器钉砧头行消化道重建26例（传统组），比较两组患者手术时间、开胸率、近端切缘癌残留率以及术后恢复情况。结果OrVilTM组患者近端切缘长度为（2．5~1．5）cm，明显长于传统组（1．6~1．1）cm（P〈O．01）；OrViFM组术中冰冻病理检查近端切缘癌残留率2．2％（1／46），无术中开胸者，而传统组则分别为23．1％（6／26）和15．4％（4／26），差异均具有统计学意义（均P〈O．01）。两组患者在术中出血量和术后并发症发生率等方面差异均无统计学意义（P〉O．05）。结论在腹腔镜辅助Siewert11型食管胃结合部腺癌根治术中应用OrVilTM行消化道重建，既安全可行，又可降低开胸率，有利于患者术后恢复。

Objective To study the safety and feasibility of transorally inserted anvil （OrVilTM） in laparoscopic-assisted radical resection for Siewert type ]] adenocarcinoma of the esophagogastric junction （AEG）. Methods Clinical data （operative time, rate of thoracotomy, residual cancer in the proximal margin, and postoperative recovery） of 72 patients suffered from Siewert type l] AEG were analyzed retrospectively, including 46 cases of applying OrVilTM in digestive tract reconstruction for laparoseopie-assisted radical resection and 26 cases of applying pouch clamp embedding anvil, between May 2009 and August 2012 in Department of Minimally Invasive Gastrointestinal Surgery at the Peking University Cancer Hospital ＆ Institute. Results The length between proximal margin and superior border of tumor was （2.5_＋1.5） cm in OrVilTM group, significantly longer than that in the traditional group [ （1.6_＋1.1） era, P〈0.01 ]. Moreover, the intraoperative frozen pathological positive incidence of cancer remnant was 2.2% （1/46）, and rate of thoracotomy was 0, both of which were significantly lower as compared to the traditional group [23.1%（6/26） and 15.4%（4/26） respectively, both P〈0.01 ].However, intraoperative blood loss and postoperative complications did not differ between the two groups （both P〉0.05）. Conclusions As for laparoscopic-assisted Siewert type I] AEG radical resection, application of OrVilTM in digestive tract reconstruction is a safe surgical procedure, and can effectively reduce the rate of intra-operative thoracotomy, which is beneficial to postoperative recovery.