全腹腔镜下全胃根治性切除术后消化道重建的临床疗效分析

Analysis of Digestive Tract Reconstruction after Totally Laparoscopic Total Gastrectomy

目的分析全腹腔镜下全胃切除术后消化道重建的安全性和短期疗效。方法回顾性分析36例全腹腔镜下全胃根治性切除术后消化道重建的胃癌患者的临床资料。结果 36例患者采用经口吻合器底钉座置入(Or VilTM)、反穿刺、食管空肠顺蠕动侧侧吻合(Overlap)、食管空肠功能性端端吻合(FETE)方法完成食管空肠重建,平均重建时间58.0 min,手术平均出血量137.7 m L,术后平均住院天数9.8天,排气天数平均为2.5天,进食流质平均天数是4.9天。术后发生1例吻合口出血,2例吻合口瘘,1例肠梗阻,1例乳糜漏,1例切口感染,总体并发症发生率为16.7%。结论全腹腔镜下全胃根治性切除术后有可以接受的消化道重建时间、出血量、术后恢复过程及并发症发生率,证明其安全、有效,可以在有经验的中心开展。

Objective This study analyzed the safety and short-term efficacy of digestive tract reconstruction after totally laparoscopic total gastrectomy.Methods Clinical and pathological data of 36 patients with gastric cancer after totally laparoscopic total gastrectomy were retrospectively analyzed.Results 36 cases of patients underwent the transorally inserted anvil(Or VilTM),Overlap side to side anastomosis,functional end-to-end anastomosis(FETE),reverse puncture device to complete the esophagojejunostomy reconstruction.The mean reconstruction time was 58.0 min and blood loss was 137.7 m L,average postoperative hospitalization period was 9.8 days,exhaust time was 2.5 days andconsumption of liquid diet was 4.9 days.Among the 36 cases,1 case had anastomotic bleeding,2 had anastomotic leakage,1 had anastomotic leakage,1 had chyle leakage and 1 had incisional wound infection,the overall complication rate was 16.7%.Conclusion Totally laparoscopic total gastrectomy has acceptable digestive tract reconstruction time,bleeding volume,postoperative recovery and complication rate.It has been proven to be safe and effective,and can be performed in experienced centers.