完全腹腔镜根治性全胃切除术后食管空肠三角吻合的近期疗效

Short-term efficacy of esophagojejunostomy by delta-shaped anastomosis in totally laparoscopic radicaltotal gastrectomy

目的探讨完全腹腔镜根治性全胃切除术中采用食管空肠三角吻合进行消化道重建的近期疗效。方法回顾性分析2013年7月至10月上海交通大学医学院附属瑞金医院收治的5例食管胃结合部腺癌和2例胃体癌患者的临床资料。7例患者进行术前评估后施行腹腔镜根治性全胃切除术，消化道重建采用完全腹腔镜下食管空肠三角吻合。术后每月门诊或电话随访，随访了解进食情况和有无胸骨后烧灼感等，随访时间截至2013年11月。结果7例患者均顺利完成完全腹腔镜根治性全胃切除和消化道重建。手术时间为（234±23）min，其中食管空肠三角吻合时间为（34±7）min，术中出血量为（153±32）mL，平均清扫淋巴结数目为（36±4）枚；术中用60mm钉仓7个。前3例患者消化道重建完成后行术中胃镜检查，吻合口通畅。7例患者术后恢复良好，术后第1天拔除胃管，术后肛门排气时间、进食流质时间以及半流质时间分别为（2．4±0．5）d、（4．0±0．6）d、（5．3±0．5）d，术后无吻合口出血、吻合口漏、吻合口狭窄、腹腔感染等手术相关并发症，无围手术期死亡。前3例患者术后第5天行上消化道造影，造影剂通过顺畅。术后病理分期：IA期3例、IB期2例、ⅡA期1例、ⅡB期1例。术后住院时间为（9．7±1．4）d。患者中位随访时间为3个月，一般情况良好，均可进食软性普通食物，无体质量减轻，无进食哽噎感和胸骨后烧灼感等症状。结论在腹腔镜胃癌根治术中进行食管空肠三角吻合安全可行。该术式吻合口大小不受食管和空肠内径限制，近期疗效满意。

Objective To investigate the short-term efficacy of esophagojejunostomy by delta-shaped anastomosis in totally laparoscopic radical total gastrectomy. Methods The clinical data of 5 patients with esoph- agogastric cancer and 2 with non-cardia gastric cancer who were admitted to the Ruijin Hospital of Shanghai Jiao- tong University School of Medicine from July to October 2013 were retrospectively analyzed. All the 7 patients received totally laparoscopic radical total gastrectomy and esophagojejunostomy by delta-shaped anastomosis after preoperative evaluation. All the patients were followed by out-patient examination and phone call till November 2013. Results The operation was successfully carried out on all the 7 patients. The operation time was （234 ＋ 23 ）minutes, and the time for delta-shaped anastomosis was （34 _＋ 7 ）minutes. The volume of intraoperative blood loss was （153 _＋ 32）mL, and the number of lymph node harvest was 36 _＋ 4. Seven staplers with 60 mm in length were applied. No anastomotic stricture was detected in the endoscopy for the first 3 patients after esophagojejnnos- tomy. All the 7 patients recovered well, and the gastric tube was removed at postoperative day 1. The time for first flatus, liquid and semi-liquid food intake were （2.4 -＋ 0.5） days, （4.0 -＋ 0.6） days, （ 5.3 ＋ 0.5 ） days, respec- tively. No anastomotic bleeding, leakage, stricture or peritoneal infection was detected. No patients died perioper- atively. Upper gastrointestinal imaging for the first 3 patients at postoperative day 5 showed unobstructed digestive tract. The numbers of patients in stage I A, I B, U A, H B were 3, 2, 1, 1. The duration of postoperative hos- pital stay was （9.7 ＋_ 1.4） days. The median time of follow-up was 3 months. The general condition of the patients was good, with no body weight loss, choking or substernal burning. Conclusions Esophagojejunostomy by delta- 1 ：_ ：~ ~^~,I｜,T 1 an;o rntlicnl fatal eastrectomv is safe and feasible. The size of anastomosis isshaped anastomosis in totally laparoscopic radical total gastrectomy, us safe abd feasuvke. THe size of anastomosis is not restriceted to the diameters of esophagus and jejunum,