食管空肠重叠法三角吻合用于胃癌腹腔镜下全胃和近端胃切除的临床疗效

Clinical efficacy of delta-shaped esophagojejunostomy using overlap method in laparoscopic total gastrectomy and proximal gastrectomy for gastric cancer

目的:探讨食管空肠重叠法三角吻合在胃癌腹腔镜全胃和近端胃切除术中临床应用的可行性和安全性。方法:回顾性分析2017年10月至2018年3月间9例胃癌病人腹腔镜胃切除的临床资料。4例近端胃癌病人行腹腔镜近端胃切除和双通道重建。1例近端胃癌和4例胃体癌病人行腹腔镜全胃切除和Roux-en-Y吻合。9例均采用食管空肠重叠法三角吻合(改良重叠法)。结果:本研究病人食管空肠重叠法三角吻合均成功完成。总手术时间为(273.9±48.2) min。食管空肠重叠法三角吻合时间为(40.9±13.3) min。术中出血量为(58.9±43.4) m L,淋巴结清扫数为(27.1±11.8)枚。上、下切缘病理检查结果均未见癌残留。术后首次肛门排气时间为(2.5±0.9) d,进流质时间为(4.8±1.3) d,术后住院时间为(7.9±1.8) d。病人均无术后并发症发生。结论:食管空肠重叠法三角吻合在胃癌腹腔镜全胃和近端胃切除术中的临床应用,可行且安全。

Objective To investigate the feasibility and safety of clinical application of delta-shaped esophagojejunostomy using overlap method in laparoscopic total gastrectomy and proximal gastrectomy for gastric cancer. Methods The clinical data of 9 patients with gastric cancer who underwent laparoscopic radical gastrectomy from October 2017 to March2018 was retrospectively analyzed. There were 4 cases with proximal gastric cancer using laparoscopic radical proximal gas-trectomy with double-tract reconstruction and 5 cases including 1 case with proximal gastric cancer and 4 cases with middle third gastric cancer using laparoscopic total gastrectomy with Roux-en-Y reconstruction. All cases underwent delta-shaped esophagojejunostomy using modified overlap method. Results All delta-shaped esophagojejunostomy using overlap method was performed successfully. Total operative time was(273.9 ±48.2) min and the time for delta-shaped overlap esophagojejunostomy was(40.9±13.3) min. Intraoperative blood loss was(58.9 ±43.4) mL and the mean lymph nodes harvested was27.1±11.8. The microscopic resection margin was cancer-free in all 9 cases. The time to first postoperative flatus and liquid diet was(2.5±0.9) d and(4.8±1.3) d, respectively. Postoperative hospital stay was(7.9±1.8) d. No postoperative complication was found in all cases. Conclusion Delta-shaped esophagojejunostomy using modified overlap method in laparoscopic total gastrectomy and proximal gastrectomy for gastric cancer would be feasible and safe, and deserves clinical practice.