食管部分断离法在腹腔镜辅助全胃切除术食管-空肠吻合中的应用

Application of Partial Esophageal Disconnection in the Laparoscopic Esophagus Jejunum Anastomosis After Total Gastrectomy

目的总结食管部分断离法在上部胃癌腹腔镜辅助全胃切除术食管-空肠吻合中的手术经验,评价其临床效果及安全性。方法回顾性分析新乡医学院第一附属医院普外科行腹腔镜辅助全胃切除术+食管-空肠Roux-en-Y重建手术治疗的28例胃癌患者临床资料。应用食管部分断离法完成圆形吻合器抵钉座包埋。观察患者手术时间、食管-空肠吻合重建时间、术中出血量、淋巴结清扫数目、术后排气时间、术后住院时间以及吻合口瘘、发热、术后出血、切口感染、吻合口狭窄等术后并发症发生情况。结果28例患者均顺利完成腹腔镜辅助全胃切除术+食管-空肠Roux-en-Y手术。手术时间(193±42)min,食管-空肠吻合重建时间(26.2±4.3)min,术中出血量为(109±32)ml,淋巴结清扫数目(28.1±7.2)枚;术后并发症发生率为14.3%(4/28),其中发热2例、术后肠道动力不足2例;术后排气时间为(3.4±0.8)d,术后住院时间(10.4±1.1)d。所有患者均未发生腹部切口感染、术后出血、吻合口瘘、吻合口狭窄。结论食管部分断离法在上部胃癌腹腔镜辅助全胃切除术食管-空肠吻合中应用,吻合操作简单,且安全可行。

Objective To summarize the surgical experience of partial esophageal disjunction in the laparoscopic esophagus jejunum anastomosis after total gastrectomy,and evaluate the clinical efficacy and safety.Methods The clinical data of 28 patients underwent laparoscopic assisted total gastrectomy and Roux-en-Y esophagojejunostomy were retrospectively analyzed.The partial esophageal disconnection was used to complete the embedding of circular stapler base.The following data of operative duration,duration of esophagojejunostomy reconstruction,bleeding in operation,number of lymph nodes dissected,postoperative exhaust time,hospitalization duration,and the incidence of anastomotic leakage,postoperative fever,postoperative bleeding,incision infection and anastomotic stenosis were surveyed.Results All 28 patients were successfully performed laparoscopic assisted total gastrectomy.Operation duration was about(193±42)min,while esophagojejunostomy reconstruction took(26.2±4.3)min.The amount of bleeding in operation was(109±32)ml,and lymph nodes dissected were(28.1±7.2).The incidence of postoperative complications was 14.3%(4/28),including 2 cases of fever and 2 cases of postoperative gastric insufficiency.Postoperative exhaust time was(3.4±0.8)d,postoperative hospitalization duration was(10.4±1.1)d.No complications,such as incision infection,postoperative bleeding,anastomotic leakage,anastomotic stenosis occurred.Conclusion The method of partial esophageal disjunction in laparoscopic assisted total gastrectomy and esophagojejunostomy is simple,easy to master,safe and feasible.