腔镜下细针导管空肠造瘘在微创McKeown食管癌切除术中的应用

Application of laparoscopic fine needle catheter jejunostomy in minimally invasive McKeown resection of esophageal cancer

目的分析腔镜下细针导管空肠造瘘的操作方法,探讨其在微创McKeown食管癌切除术中的应用效果。方法收集2010年1月至2017年12月山东大学齐鲁医院单一手术团队完成的1023例微创McKeown食管癌切除术患者的临床资料,回顾性分析术中腔镜下细针导管空肠造瘘的完成情况,及术后造瘘管口渗液、造瘘管管腔堵塞、肠梗阻等造瘘相关并发症的发生率。结果1023例患者均在腔镜下顺利完成细针导管空肠造瘘,平均手术时间(14.77±2.99)min,平均出血量(2.87±0.96)mL;有9例(0.88%)患者出现空肠造瘘相关并发症,其中造瘘管口渗液3例(改行肠外营养支持,及时换药,保持造瘘口周围皮肤清洁,局部涂抹氧化锌软膏)、造瘘管管腔堵塞3例(经口进食前行肠外营养支持)、空肠瘘1例(行2次手术)、肠系膜扭转1例(行2次手术)、不完全肠梗阻1例(行保守治疗)。结论微创McKeown食管癌切除术中行腔镜下细针导管空肠造瘘,操作简便、安全可行,是建立术后早期肠内营养的有效途径,值得临床推广应用。

Objective To analyze the operative methods of laparoscopic fine needle catheter jejunostomy,and to investigate its application effects in minimally invasive McKeown resection of esophageal cancer.Methods Clinical data of 1023 cases undergoing minimally invasive McKeown resection of esophageal cancer by single-operation group were collected from January 2010 to December 2017.The performance of fine needle catheter jejunostomy under laparoscopy,and the incidence of complications related to jejunostomy,such as postoperative catheter site fistula,tube obstruction,intestinal obstruction and so on,were retrospectively analyzed.Results The fine needle catheter jejunostomy were successfully completed in all patients under laparoscopy,and the average operating time was(14.77±2.99)minutes,the mean bleeding volume was(2.87±0.96)mL.The complications related to jejunostomy occurred in 9 cases(0.88%),of which,3 cases with catheter site fistula(the enteral nutrition was changed to parenteral nutrition,the dressing was changed in time,the skin around the stoma was kept clean,and zinc oxide ointment was applied locally),3 cases with tube obstruction(parenteral nutrition support was performed before oral feeding),1 case with jejunal fistula(a second operation was performed),1 case with mesenteric torsion(a second operation was performed),and 1 case with incomplete intestinal obstruction(the conservative therapy was performed).Conclusion The laparascopic fine needle catheter jejunostomy is an effective approach to establish postoperative enteral nutrition for patients undergoing minimally invasive McKeown resection of esophageal cancer.The method is simple and convenient,safe and feasible,so worthy of clinical application.