手工缝合法食管空肠吻合在全腹腔镜全胃切除术中应用

Application of intracorporeal hand-sewn esophagojejunostomy after totally laparoscopic total gastrectomy

全腹腔镜全胃切除术(TLTG)后手工缝合法食管空肠吻合口重建的所有操作均在直视下完成,具有原位吻合安全确切、对食管残端游离长度要求较低、经济性高等特点。2012年至今,浙江省人民医院已完成TLTG后手工缝合法食管空肠吻合63例,无中转开腹,手术时间(273.4±52.3)min,食管空肠吻合时间(61.4±19.2)min。术后下床活动时间为(2.1±1.0)d,肛门排气时间为(3.1±0.9)d,进食流质时间为(4.2±1.0)d,术后住院时间(8.1±2.4)d,术后无吻合口漏、狭窄。良好的显露、术者腹腔镜下缝合经验和配合默契的团队,是顺利进行手工缝合法腹腔镜食管空肠吻合的关键。

Intracorporeal hand-sewn esophagojejunostomy after totally laparoscopic total gastrectomy （TLTG） is feasible and safe. The suturing process can be totally and clearlymanipulated under laparoscopy to ensure the anastomosis reliability besides being cost-effective. The approach requires no excessive mobilization of the esophagus and Roux limb and less tissue injury of anastomosis site. From 2012, A total of 63 consecutive patients underwent TLTG with intracorporeal hand-sewn end-to-side esophagojejunostomy in Zhejiang Provincial People＇ s Hospital. The mean operation time was （273.4±52.3） min. The mean reconstruction time was （61.4± 19.2） min, without any conversion to open surgery or laparoscopy assisted surgery. The average time to out-of-bed activity was （2.1 ± 1.0） d. The average time until the first flatus was （3.1 ±0.9）d. The average time to start liquid diet was （4.2± 1.0） d. The average postoperative hospital stay was （8.1 ± 2.4） d. There was no sign of anastomotic leaks and strictures in any patient. The key to perform intracorporeal hand-sewn esophagojejunostomy after laparoscopie total gastrectomy is well exposure, extensive experience and closely cooperated team.