三角吻合在腹腔镜全胃切除术后食管空肠吻合中的应用及技巧

Application and skills of triangle anastomosis technique in the laparoscopic esophagus jejunum anastomosis after total gastrectomy

目的:探讨三角吻合技术在腹腔镜全胃切除术后食管空肠吻合中的应用与技巧。方法:回顾分析2013年6月至2015年5月施行的67例全腹腔镜全胃切除术中食管空肠三角吻合病例的临床资料。采取暴露术野、多方向置入直线切割器的方法使食管空肠三角吻合更加简易、有效、安全。结果:67例患者均成功施行全腹腔镜下胃癌根治全胃切除+淋巴结清扫(D2),并应用三角吻合完成食管空肠吻合。手术时间平均(180±30)min,三角吻合平均耗时(15±2)min;肿瘤距上切缘距离均超过2 cm,上切缘病理检查结果均未见癌残留。术中出血量平均(75±50)ml,淋巴结清扫数量均大于30枚。8例出现不同程度乳糜漏,2例出现十二指肠残端漏,经对症处理后均好转。未出现食管空肠吻合口出血、吻合口漏等并发症。1个月后复查上消化道造影,均提示吻合口通畅,无吻合口狭窄。结论:完全腹腔镜食管空肠三角吻合法的手术技术通过改进后视野更好,吻合操作易于掌握,且真正达到了三角吻合的目的,吻合口径更大,还可降低吻合口出血及漏等并发症发生率。

Objective： To explore the application and skills of triangle anastomosis technique in esophageal jejunum anastomosis after laparoscopic total gastrectomy. Methods： The clinical data of 67 patients,who underwent triangle anastomosis of esophageal jejunum in totally laparoscopic total gastrectomy from Jun. 2013 to May 2015,were retrospectively analyzed. The triangle anastomosis of esophagus jejunum turned out to be simpler,more effective and safer through exposing operation field and multi-direction placement of a linear cutter. Results： All 67 patients were successfully performed laparoscopic radical gastrectomy for gastric cancer with lymph node dissection（ D2）,and the anastomosis was performed via triangular anastomosis. Operation time was about（ 180 ± 30） min,while triangular anastomosis took（ 15 ± 2） min. The distance between the upper cutting edge and the edge of the tumor was more than 2 cm,and the pathological examination results showed no residual tumor. The amount of bleeding in operation was（ 75 ± 50） ml,and lymph node dissected was more than 30. Among 67 patients,8 cases suffered from different degrees of chylous fistula,and 2 cases from duodenal stump leakage,which were improved after symptomatic treatment. No complications,such as anastomotic hemorrhage,anastomotic leakage,etc,occurred. The upper digestive tract examination one month later indicated the anastomotic patency without anastomotic stenosis.Conclusions： The operative field of the complete laparoscopic triangle anastomosis of esophagus jejunum becomes better after the improvement. The anastomosis technique is easy to master,and realizes triangle anastomosis in deed that can enlarge diameter,reduce incidence of anastomotic bleeding,leakage and other complications,has great clinical application value.