完全腹腔镜远端胃癌D2根治术

Total laparoscopic D2 distal gastrectomy for gastric cancer

近年来,随着腹腔镜手术技术和器械的发展,完全腹腔镜远端胃癌根治术在国内逐渐开展,主要难点问题仍集中于消化道重建。完全腹腔镜远端胃癌根治术的消化道重建方式主要有B-Ⅰ式三角吻合,B-Ⅱ式吻合和Roux-en-Y吻合等。B-Ⅰ式三角吻合法操作简便,但较适合于早期胃癌患者;B-Ⅱ式操作简单,但易出现碱性反流性胃炎;Roux-en-Y吻合能有效避免反流,但术后停滞综合征发生率较高,且全腹腔镜下操作繁琐。笔者2013年9月在国内率先开展全腔镜下胃空肠Uncut Roux-en-Y吻合,该方式既保证了肠道的连续性,降低了停滞综合征的发生率,又有效阻断了胆胰液反流至胃肠吻合口,且全腔镜下实施简便、并发症少,安全有效,值得推荐。

With the development of surgical technique and instrument, total laparoscopic D2 distal gastrectomy for gastric cancer has been popular. But the reconstruction of the digestive tract remains difficult in total laparoscopie gastrectomy. The reconstruction procedures for total laparoscopic D2 distal gastrectomy included Billroth I with Delta-shaped anastomosis, Billroth II anastomosis, Roux-en-Y anastomosis, etc. Billroth I with Delta-shaped anastomosis is simple and fits for early-staging gastric cancers. Billroth II anastomosis is simple, but alkaline reflux gastritis might occur after operation. Roux-en-Y anastomosis could avoid alkaline reflux gastritis; however it is difficult to perform under laparoscopy, and stasis syndrome might occur after operation. The authors first performed uncut Roux-en-Y anastomosis in September 2013 in China, which could not only avoid alkaline reflux gastritis but also lower the incidence of stasis syndrome. In our opinion, uncut Roux-en-Y anastomosis is simple, safe and feasible in total laparoscopic D2 distal gastrectomy.