完全腹腔镜全胃切除术后消化道重建的难点与技巧

Difficulty and skill of digestive tract reconstruction after ;totally laparoscopic total gastrectomy

随着腹腔镜技术近年来的规范与推广，腹腔镜根治性全胃切除术得到越来越多的开展，其主要的难点问题仍集中于全胃切除后的消化道重建。完全腹腔镜下的重建方式首选食管空肠Roux-en-Y吻合，其吻合方式主要有两种，即应用圆形吻合器行食管空肠端侧吻合和应用直线切割吻合器行食管空肠侧侧吻合，两种方法各有利弊，后者吻合口径更大。完全腹腔镜全胃切除术后消化道重建的优势在于，吻合全程在腹腔镜直视下进行，视野更好，安全性更高，手术创伤更小，是一种较为安全、简便、有效的吻合方法。

In recent years, with the standardization and promotion of laparoscopic techniques, the use of laparoscopic radical total gastrectomy is increasing. The main difficult points of this technique focus on digestive tract reconstruction after total gastrectomy. Esophagojejunal Roux-en-Y anastomosis is the first choice in laparoscopic reconstruction. There are two main methods for totally laparoscopic total gastrectomy （TLTG）. One is esophagojejunal end-to-side anastomosis using circular stapler , and the other is esophagojejunal side-to-side anastomosis using linear staplers. TLTG has its advantages in digestive tract reconstruction including better visualization high safety and less trauma, which makes it a safe, convenient and effective method for reconstruction.