经自然腔道取出标本的全腹腔镜远端胃癌根治术(Uncut Roux-en-Y吻合)七例报告

Uncut Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy with specimen extraction through natural orifice: A report of 7 cases

目的探讨经自然腔道取出标本的全腹腔镜远端胃癌根治术(Uncut Roux-en-Y吻合)的安全性、可行性及近期效果。方法回顾性分析2017年1月至2017年5月淄博市临淄区人民医院实施的全腹腔镜远端胃癌D2根治术(胃空肠Uncut Roux-en-Y吻合)7例的临床资料。结果 7例病例均在全腹腔镜下成功完成,经自然腔道(阴道或直肠)取标本,无中转开腹,无术中并发症,无手术相关死亡。手术中位时间为280(260~320)min,其中消化道重建时间为45(35~55)min,术中中位失血为90(30~120)ml。术后中位排气时间2(1~3)d,手术后中位住院天数8(7~13)d。无吻合口漏、Roux滞留综合征(RSS)和直肠狭窄等相关并发症发生。结论腹部无辅助切口经自然腔道取标本的全腹腔镜远端胃癌根治术(胃空肠Uncut Roux-en-Y吻合)安全、可行,既避免术后胆汁反流性胃炎,又避免了Roux-en-Y吻合的Roux滞留综合征;经自然腔道标本取出,进一步减少创伤,减轻术后疼痛,手术时间无明显延长。

ObjectiveTo investigate the safety, feasibility and short term outcome of totally laparoscopic uncut Roux-en-Y anastomosis in the distal gastrectomy for gastric cancer with specimen extraction through natural orifice. MethodsThe clinical data of seven cases of total laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D2 dissection for gastric cancer from January 2017 to May 2017 in Linzi District Hospital were analyzed retrospectively. The operation time, intraoperative bleeding volume, number of lymph nodes resected, incidence of complication, length of hospital stay and follow-up were observed. ResultsAll of them underwent total laparoscopic uncut Roux-en-Y anastomosis. All the procedures were performed successfully. There were neither conversions to open surgery, nor intraoperative complications in all seven cases. The median time of the operation was 280 （260~320） min and the median time of anastomosis was 45 （35~55） min. The blood loss was 90 （30~120） ml. The time to fatus and length of postoperative hospital stay were 2 （1~3） d and 8 （7~13） d, respectively. No major postoperative complication occurred, such as anastomotic leak, Roux stasis syndrome and rectal stenosis. ConclusionThe totally laparoscopic uncut Roux-en-Y anastomosis in distal gastrectomy with lymph node dissection for gastric cancer is safe and feasible, with a very low rate of re？ux gastritis; laparoscopic distal gastrectomy with specimen extraction through natural ori？ce has the less trauma, lighter postoperative pain, and the operation time is not signi？cantly prolonged.