反穿刺技术在腹腔镜近端胃切除食管-残胃吻合中的应用价值

Application Value of Reverse Puncture in Laparoscopic Proximal Gastrectomy and Esophagus-Gastric Remnant Anastomosis

目的探讨反穿刺技术在腹腔镜近端胃切除食管-残胃吻合手术中的安全性和应用价值。方法我科2014年5月~2015年5月在腹腔镜近端胃切除手术中采用反穿刺技术,即切开食管前壁置入反穿刺器,由切口上方3 cm穿出导线后闭合食管完成吻合器钉座置入,再通过辅助小切口在镜下完成食管-残胃吻合11例。结果 11例手术均获得成功,无中转开腹手术。手术时间(212.1±47.9)min,完成吻合时间(63.5±9.7)min,钉座置入时间(20.5±6.8)min,术中出血量(136±28)ml,辅助切口长度(4.6±0.5)cm,术后排气时间(2.3±0.6)d,住院时间(10.7±2.2)d,肿瘤距食管断端距离(4.3±1.1)cm。围手术期无死亡,无吻合口漏、吻合口出血等并发症发生。术后病理食管断端均未见肿瘤浸润。11例随访(17.8±3.2)月,无复发,术后3个月发现吻合口狭窄1例,经内镜下扩张后缓解。结论反穿刺技术在腹腔镜近端胃切除手术中完成食管-残胃吻合能简化手术操作,简单易行,安全可靠,是一种值得推广的吻合方式。

Objective To investigate the safety and application value of the reverse puncture technique in laparoscopic proximal gastrectomy and esophagus-gastric remnant anastomosis. Methods Reverse puncture technique was adopted in 11 cases of laparoscopic proximal gastrectomy in our department from May 2014 to May 2015. The esophageal anterior wall was opened to introduce the reverse device. After the guide wire was extracted from the esophagus 3 cm above the incision,the esophagus was closed to complete the implantation of stapler nail seat. Then gastric-esophageal anastomosis was completed under the microscope through auxiliary small incision. Results The operations were successfully completed in all the 11 cases. The operation time was（ 212. 1 ±47. 9） min,the time to complete anastomosis was（ 63. 5 ± 9. 7） min,the nail seat implantation time was（ 20. 5 ± 6. 8） min,the blood loss was（ 136 ± 28） ml,the auxiliary incision length was（ 4. 6 ± 0. 5） cm,the postoperative discharge time was（ 2. 3 ± 0. 6）d,the hospital stay was（ 10. 7 ± 2. 2） d,and the tumor distance from the end of the esophagus was（ 4. 3 ± 1. 1） cm. No perioperative mortality, anastomotic leakage, anastomotic bleeding or other complications occurred. Postoperative pathological examination of esophageal stump showed no tumor infiltration. The postoperative follow-up for（ 17. 8 ± 3. 2） months in the 11 cases found no recurrence. One case was found anastomotic stenosis after 3 months,which was relieved after endoscopic dilatation. Conclusion Reverse puncture can be operated simply and feasibly in laparoscopic proximal gastrectomy and esophagus-gastric remnant anastomosis.