经口输送钉砧系统(OrVil)技术在全腹腔镜胃癌根治术中的应用

Application of transorally inserted anvil delivery system(OrVil) for totally laparoscopic radical gastrectomy

目的:探讨经口输送钉砧系统(Or Vil)技术在全腹腔镜胃中上部癌根治术中应用的可行性及其临床疗效。方法:2014年1-9月期间,对我院45例胃中上部癌患者施行胃癌D2根治术,其中施行全腹腔镜胃中上部癌根治术并Or Vil技术行食管空肠吻合术的患者(Or Vil组)20例,常规开腹全胃切除患者(开腹组)25例。比较2组患者术中、术后情况及并发症发生率的差异。结果:Or Vil组患者中1例因空肠肠腔细小无法置入吻合器而中转开腹,余均成功应用Or Vil技术行食管空肠吻合术。2组患者手术时间、术中输血例数、淋巴结清扫数目差异无统计学意义(P>0.05)。Or Vil组术中出血量较开腹组少,术后首次排气时间、首次进食流质时间和术后住院时间较开腹组短,差异均有统计学意义(P<0.05)。2组患者术后并发症发生率分别为10%和20%,差异无统计学意义(P>0.05)。结论:Or Vil技术应用于全腹腔镜下胃上部癌根治术是安全可行的,近期疗效满意。

Objective： To evaluate the technical feasibility, safety, and clinical efficacy of the technique oftransorally inserted anvil delivery system （OrVil） for totally laparoscopic gastrectomy. Methods： From January 2014 to September 2014, 45 gastric cancer patients underwent D2 lymph node dissection. Of these, 20 patients underwent transoral OrVil EEA stapler for totally laparoscopic gastrectomy （OrVil group）, while 25 patients underwent conventional open gastrectomy （OG group）. The recovery and complication rate were compared between two groups. Results： Transoral OrVil EEA stapler for totally laparoscopic gastrectomy was successfully carried out in all the patients except for 1 case who was convened to open surgery. The operation time, the mean number of removal lymph node and number of patients needed blood transfusion were not significantly between two groups. However, compared to OG group, the mean blood loss were less, and first flatus time, time to resume soft diet and postoperative hospital stay were shorter in OrVil group （all P〈0.05）. The postoperative morbidity in OrVil group and OG group were 10% and 20%, respectively （P〉0.05）. Conclusion： OrVil is a safe and feasible procedure for totally laparoscopic Radical gastrectomy and provides satisfactory short-term efficacy.