全腹腔镜胃癌根治术消化道重建及相关并发症处理

Digestive tract reconstruction and its complications after totally laparoscopic gastrectomy for gastric cancer

全腹腔镜远端胃癌根治术消化道重建方式主要为BillrothⅠ式三角吻合、BillrothⅡ式吻合和胃空肠Roux-enY吻合。BillrothⅠ式三角吻合的应用须严格把握适应证,而胃空肠Roux-en-Y吻合近年来有增多趋势,BillrothⅡ式+Braun吻合和非离断式Roux-en-Y吻合较Roux-en-Y吻合更简单易行,在全腹腔镜下操作时更易于掌握。全腹腔镜全胃切除术消化道重建可分为腔内直线切割闭合器吻合与圆形吻合器吻合两种方式,当前对各类应用直线切割闭合器进行重建的关注多于圆形吻合器。随着直线切割闭合器在全腹腔镜下的应用逐渐成熟,其各种优势开始逐渐显现,并且是真正意义上的全腹腔镜吻合方式。由于全腹腔镜下重建较小切口辅助手术视野更好,操作空间更大,吻合过程均在腹腔镜监视下完成,而且随着腹腔镜下切割吻合器械的研发与改进,其吻合更安全可靠,且并发症的发生率亦逐渐降低。

The digestive tract reconstruction includes Delta anastomoses （Billroth Ⅰ）, Billroth Ⅱ anastomoses, and gastro-jejunal Roux-en-Y anastomoses in totally laparoscopic distal gastrectomy （TLDG）. Billroth I with Delta anastomoses has a strict indication in TLDG. Gastro-jejunal Roux-en-Y anastomoses is now more popular. Billroth II with Braun anastomoses and uncut Roux-en-Y anastomoses are technically easier to carry on in TLDG than Roux-en-Y. The digestive tract reconstruction includes anastomoses using linear stapler and circular stapler in totally laparoscopic total gastrectomy （TLTG）. Linear stapler has more advantages in TLTG recently because it is a real ＂total laparoscopy＂ technique. The GI tract reconstruction in totally laparoscopic gastrectomy has a better visualization and a better working place than the reconstruction in a small incision. With the development of the technique and skill, the complication rate becomes lower recently.