胃-食管预制机器人胸内手工分层吻合——一种胃-食管胸内吻合的新策略

Pretreatment-facilitated robot intrathoracic layered anastomosis—a novel strategy for robotic intrathoracic anastomosis between the esophagus and gastric conduit

目的报告胃-食管预制机器人胸内手工分层吻合(PRILA)的技术特点。方法术前活检确诊为食管癌并愿意接受机器人辅助微创食管切除术(RAMIE)的患者为本研究纳入对象。胃食管吻合前预处理措施主要包括以下四方面:以胸骨角为标志在体外完成管状胃的预制;吻合前采用冷造口的方法在胃前壁造口;采取保护性胃包裹及传动法拖曳管状胃进入胸腔的方式;采用腔内阻断的方法夹闭食管近端,以减少吻合时食管端出血。术后每半年随访一次以追踪患者转归。结果2018年9月至2019年7月,12名食管癌患者采用PRILA术式顺利完成了肿瘤切除及消化道重建,均未发生中转开胸。所有患者取得R0切除,术后均未发生吻合口瘘。术后住院时间平均9.9天,出院时所有患者可耐受半流质饮食,术后随访1年均未发生肿瘤复发或转移。结论胃-食管PRILA在食管癌的外科治疗中安全可行。该术式通过对食管及管状胃的预处理,为术者提供了一个清晰的术野,保证了手术的流畅性和分层吻合的精确性。该方法为胸外科医师应对胃-食管胸内吻合的挑战提供了一条新策略。

Objective To report the experience of pretreatment-facilitated robot intrathoracic layered anastomosis(PRILA).Methods Patients with esophageal cancer proved by biopsy and willing to accept robotassisted minimally invasive esophagectomy(RAMIE)were included in this study.The pretreatments before anastomosis included the following procedures.Firstly,we used the sternal angle as a marker to confirm the length of the gastric conduit so that we could construct the conduit outside the body.Secondly,cold scissors,rather than the electrocoagulation equipment,were used in making the gastrostomy.Thirdly,the gastric conduit was carefully packaged with single-layered gauze before we move it into the thoracic cavity.Lastly,an intrathoracic clamp was placed on the proximal esophageal stump to reduce the bleeding of the stump.An interview was performed every half-year after the surgery to track the postoperative outcomes.Results Between September 2018 and July 2019,12 patients with esophageal cancer received PRILA for tumor resection and digestive tract reconstruction.All the patients achieved R0 resection,and no patient suffered from an anastomotic leakage.The mean length of postoperative stay was 9.9 day.All patients could receive semiliquid diet when discharged.No relapse or metastasis happened in the first year after the surgery.Conclusion PRILA is a safe and feasible procedure with favorable surgical outcomes.The pretreatment procedures provide us a clean surgical field so that the anastomosis could be performed fluently and accurately.It provides surgeons a new strategy to handle the challenges of the intrathoracic robotic anastomosis.