腹腔镜全胃切除术后不同食管空肠吻合方法临床应用探讨

Clinical analysis of 7 methods of laparoscopic esophagojejunostomy after total gastrectomy

目的介绍完全腹腔镜全胃切除术后7种食管空肠吻合方法。方法回顾性分析2011年12月至2015年6月广东省中医院胃肠外科收治的胃癌病人93例临床资料,接受全胃切除后行完全腹腔镜食管空肠Roux-enY吻合,其中圆形吻合器法包括反穿刺、侧方置入、直接置入、荷包缝合及经口钉砧座置入装置(Or VilTM),直线切割闭合器法包括食管空肠顺蠕动侧侧吻合(Overlap)和食管空肠功能性端端吻合(FETE)。分析术中及术后结果。结果手术时间(293.7±85.3)min,食管空肠吻合时间(23.0±5.8)min,直接置入法在食管空肠吻合时间上略显优势,平均时间(18.2±3.7)min。术中并发症4例,术后并发症3例,均处理成功,无手术相关死亡。结论 7种完全腹腔镜下全胃切除术后食管空肠Roux-en-Y吻合均安全可行。

Objective To introduce 7 methods of laparoscopic esophagojejunostomy after total gastrectomy. Methods The clinical data of 93 patients with gastric caner underwent totally laparoscopic total gastrectomy and Roux-en-Y esophagojejunostomy from December 2011 to June 2015 in Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine were analyzed retrospectively. There were 5 methods of anvil insertion for circular stapling which containing reverse puncture device, anvil lateral insertion, anvil direct insertion, purse string suture and OrVilTM. For linear stapling, there were two methods namely Overlap and FETE. The operative time, blood loss and morbidity of different methods were reviewed. Results The mean operative time was （293.7±85.3） min with a mean esophagojejunostomy time of （23.0 ± 5.8） mL. Anvil direct insertion was superior to the time of esophagojejunostomy with a mean esophagojejunostomy time of （18.2±3.7）min. Intraoperative complication occurred in 4 patients and postoperative complication occurred in 3 patients. They were all cured with conservative methods. No death was recorded. Conclusion The 7 methods of totally laparoseopie esophagojejunostomy after total gastrectomy are safe and feasible.