经口放置抵钉座装置在腹腔镜胃切除食管-残胃(空肠)吻合术中的应用

Application of the transorally inserted anvil in esophagojejunostomy or esophagogastrostomy after laparoscopic gastrectomy

目的:总结经口放置抵钉座装置完成腹腔镜胃切除食管-空肠(残胃)吻合术的临床经验。方法:回顾分析2012年10月至2013年10月为60例胃肿瘤患者行腹腔镜食管-残胃(空肠)吻合术的临床资料,患者行腹腔镜近端胃或全胃切除术,恶性肿瘤患者加行淋巴结清扫,利用经口放置抵钉座装置完成食管-残胃(空肠)吻合。结果:60例患者均顺利完成手术,无一例中转开腹,抵钉座放置顺利。手术时间平均(164±45)min;术中出血量平均(192±128)ml;术后发生并发症5例。49例患者获得随访,其中1例发生骨转移并死亡,余者均无肿瘤复发与转移。结论:经口放置抵钉座装置应用于腹腔镜食管-残胃(空肠)吻合术是安全、可行的,可适当扩大手术适应证,但仍存在一定的设计缺陷与弊端,需进一步改进手术器械,以增加易用性与安全性。

Objective：To summarize the clinical application of the transorally inserted anvil in esophagojejunostomy or esopha- gogastrostomy after laparoscopie gastrectomy. Methods：The clinical data of 60 patients with gastric neoplasms who were executed by laparoseopic esophagojejunostomy or esophagogastrostomy at the Changhai Hospital from Oct. 2012 to Oct. 2013 were retrospectively an- alyzed. All patients were performed laparoscopic proximal gastrectomy or laparoscopie total gastrectomy, and radical dissection of lymph nodes was added for malignant tumors, esophagojejunostomy or esophagogastrostomy were accomplished with using of transorally inserted anvil （ OrVilTM ）. Results ： Sixty patients were all operated successfully, there were no conversions to the open gastrectomy, OrVilTM was installed successfully. The mean operation time was （164 ± 45 ） rain and the mean blood loss was （192 ± 128） ml. There were 5 postop- erative complications. A total of 49 patients got follow-up visit, 1 patient came up with osseous metastasis and mortality, then others with- out neoplasms recurrence or metastasis. Conclusions：The application of the transorally inserted anvil （OrVilTM） in esophagojejunosto- my or esophagogastrostomy after laparoscopic gastrectomy is a safe and reliable anastomotic technique,it may be appropriate to expand the indications for surgery, but still there are some design flaws and shortcomings which need to be further improved in order to increase the ease of use of surgical instruments and safety.