胃空肠“裤形吻合”在腹腔镜辅助远端胃癌根治术中的应用

Application of Pants-like Anamostosis in Laparoscopy-assisted Distal Radical Gastrectomy

目的探讨胃空肠“裤形吻合”在腹腔镜辅助远端胃癌根治消化道重建中应用的安全性和可行性。方法2018年6~12月,采用胃空肠裤形吻合完成腹腔镜远端胃癌根治后毕Ⅱ式消化道重建96例。腹腔镜下胃切除完成后,上腹正中做5~7 cm切口。在拟行胃空肠吻合前,用直线切割闭合器在空肠肠壁开口处行空肠输入输出襻侧侧吻合,用圆形吻合器吻合输入输出襻共同开口于残胃。结果96例手术均获成功,切口长度4.8~6.8 cm(平均5.3 cm),手术总时间125~235 min(平均155.8 min),消化道重建时间15~33 min(平均22 min),术中出血量20~200 ml(平均50 ml),术后排气时间3~5 d(平均3.5 d),进流食时间2~3 d(平均2.7 d),进半流食时间4~6 d(平均5.5 d),术后住院时间7~12 d(平均8.2 d)。围手术期无严重并发症。术后随访3~9个月(平均6个月),1例小肠梗阻,保守治疗,无其他并发症。结论胃空肠裤形吻合操作简单、快捷,不增加手术复杂度,用于腹腔镜远端胃癌根治毕Ⅱ式消化道重建安全、可行。

Objective To investigate the application of pants-like anastomosis in laparoscopy-assisted distal radical gastrectomy,and to evaluate its safety and feasibility.Methods From June 2018 to December 2018,ninety-six distal gastric cancer patients were enrolled to receive laparoscopy-assisted distal radical gastrectomy with pants-like anastomosis.After laparoscopic gastrectomy,a 5-7 cm long incision was made in the middle of the upper abdomen.Pants-like anastomosis was designed as a reformation of traditional Billroth-Ⅱgastrojejunostomy.A linear stapler was used to introduce a side-side anastomosis at the end of the afferent and efferent loops of jejunum.After that,the jejunal pouch,which looked like a pair of pants,was anastomosed to the remnant stomach.Results All the laparoscopic operations of the 96 patients were successful and uneventful.The incision length was 4.8-6.8 cm(average,5.3 cm).The total operation time was 125-235 min(average,155.8 min).The time of digestive tract reconstruction was 15-33 min(average,22 min).The bleeding volume during the operation was 20-200 ml(average,50 ml).The anal exhaust time was 3-5 days(average,3.5 days).Liquid diet was started from the 2-3 day(average,2.7 day)and semi-liquid diet from the 4-6 day(average,5.5 day).The discharge time was 7-12 days(average,8.2 days).No serious complications were observed during the perioperative period.The follow-up period was 3-9 months(average,6 months).No complications occurred except for one case of intestinal obstruction,which was managed successfully with conservative treatment.Conclusions The pants-like anastomosis is simple and fast.It does not increase the complexity of operation and has fewer complications.It is safe and feasible to be used in laparoscopy-assisted distal radical gastrectomy.