全腹腔镜下胃肠Roux-en-Y吻合在胃远端切除术中的应用

Application of totally laparoscopic Roux-en-Y gastrojejunostomy following total laparoscopic distal gastrectomy

随着微创外科的发展和进步,腹腔镜胃癌手术已实现规范化的淋巴结清扫,并呈现出取代传统开腹手术的趋势。在保证手术根治性的前提下,患者的手术安全和生存质量日渐受到关注。而理想的消化道重建不仅能够保障手术本身的安全性,更能够保证胃癌患者术后的生存质量。因此,全腹腔镜下消化道重建成为国内外学者关注的热点。远端胃癌根治术是最常见的术式,而术后的远期效果和生存质量均以Roux-en-Y胃肠吻合为优。但全腹腔镜下Roux-en-Y胃肠吻合操作技术复杂,制约了其临床普及。故探索全腹腔镜Roux-en-Y胃肠吻合成为腹腔镜手术发展中需要解决的重要问题。本文将对腹腔镜远端切除术后Roux-en-Y胃肠吻合在远端胃切除术中应用进行评价,介绍腹腔镜下Roux-en-Y胃肠吻合手术经验,针对手术技巧予以总结,以提高我国的腹腔镜胃癌手术水平。

Due to progresses ofrninimally invasive surgery, standard lymphadenectomy had been performed successfully by laparoseopic gastreetomy, which showed a trend to replace open gastreetomy. Gradually, it attracted widespread concern in acquiring safety of surgery and quality of life after radical surgery. Furthermore, ideal reconstruction kept an eye on the both after gastrectomy. As such, scholars focused on totally laparoscopic reconstruction. In the surgical treatment, distal gastrectomy was known to be the most conventional procedures, while Roux-en-Y gastrojejunostomy was shown to provide comparable long-term outcomes and quality of life. With respect to clinical application, it was hampered by the complexity of totally laparoscopic Roux-en-Y anastomosis. And it became a great unsolved problem in laparoseopic surgery. Outcomes were summarized on application of total laparoscopic gastrojejunostomy, and experienced skills were acquired by management of Roux-en-Y procedures, which promote the developments of laparoseopic gastrectomy.