腹腔镜胃癌手术中高位食管空肠吻合重点与难点

Key points and difficulties of high esophagojejunal anastomosis in laparoscopic gastrectomy for gastric cancer

随着腹腔镜胃癌手术的普及,作为关键步骤的常规食管空肠吻合技术已逐步成熟,但中高位食管空肠吻合由于位置高而深导致吻合操作困难及术后吻合口并发症发生率高等问题。合适的手术入路和充分的术野暴露是降低腹腔镜中高位食管空肠吻合操作难度的必要手段,而管型吻合或线性吻合方式和方法的选择及操作技巧更是需要术者仔细考量。在现阶段腹腔镜下使用线型切割缝合器行食管空肠侧侧吻合可能是最常用的选择,但在中高位吻合时管型吻合器具有诸多优势,两种方式各有利弊,临床实践中需在把握适应证同时注重操作细节,以便更好地完成中高位食管空肠吻合。

With the gradual popularization of laparoscopic gastric cancer surgery,the conventional esophagojejunal anastomosis technology,as a key step,has gradually become mature.However,due to the high depth of the position,the operation of mid to high esophagojejunal anastomosis is difficult,and there are still high operational risks and a high incidence of postoperative anastomotic complications.A suitable surgical approach and sufficient exposure of the surgical field are necessary means to reduce the difficulty of high esophagojejunal anastomosis in laparoscopic surgery,and the selection of circular stapler or linear stapler,as well as the operational skills,require careful consideration by the surgeon.At present,using a linear stapler for esophagojejunal anastomosis under laparoscopy may be the most commonly used choice,but in mid to high-level anastomosis,the circular stapler has many advantages,and each method has its own advantages and disadvantages.In clinical practice,it is necessary to grasp the indications while paying attention to operational details in order to better complete mid to high-level esophagojejunal anastomosis.