小切口辅助下腹腔镜全胃切除术后管型器械吻合在食管空肠重建中的临床研究  

A clinical study of laparoscopic total gastrectomy assisted by small incision and subsequent gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction

作　　者：林文发 钱振渊[2] 蔡徐帆 叶再元[2] Lin Wenfa;Qian Zhenyuan;Cai Xufan;Ye Zaiyuan(Department of Gastrointestinal Surgery,the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou 310053,China;General Surgery,Department of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People′s Hospital(Affiliated People′s Hospital,Hangzhou Medical College),Hangzhou 310014,China;Graduate School of Zhejiang University of Traditional Chinese Medicine,Hangzhou 330022,China)

机构地区：[1]浙江中医药大学附属第二医院胃肠外科,杭州310053 [2]浙江省人民医院(杭州医学院附属人民医院)普通外科胃肠胰外科,杭州310014 [3]浙江中医药大学研究生院,杭州330022

出　　处：《中国医师杂志》2023年第10期1458-1463,共6页Journal of Chinese Physician

摘　　要：目的介绍小切口辅助下腹腔镜全胃切除术+管型器械吻合法完成食管空肠重建的操作过程,并评价其操作可行性、围手术期安全性及吻合优势。方法选择2022年5月至2023年6月就诊于浙江省人民医院的行小切口辅助下腹腔镜全胃切除术+管型器械吻合法完成食管空肠重建的56例胃癌患者作为研究对象,收集患者的性别、年龄、BMI、肿瘤位置、肿瘤分期、肿瘤类型等。统计手术过程中的主要参数指标,如手术时间、吻合时间、术中出血量、术后恢复情况、排气时间、进食时间、吻合口相关并发症、住院时间等指标,并横向对比分析其他研究中Overlap法、反穿刺法、手工吻合等消化道重建方式的相关指标。结果本研究共纳入56例胃癌患者。管型器械组患者的吻合时间为(42.3±15.7)min,优于手工吻合法(P<0.05);管型器械组手术时间为(176.3±25.8)min,优于其余术式(均P<0.05);管型器械组术中出血量为(75.7±20.3)ml,少于其余术式(均P<0.05);管型器械组排气时间为(2.6±0.2)d,与Overlap法相近(P>0.05),早于手工吻合、反穿刺法(均P<0.05);管型器械组吻合口瘘发生率与手工吻合法、反穿刺法、Overlap法相近(P>0.05);各组间患者的术后住院时间、切口感染率、吻合口其余并发症情况差异无统计学意义(均P>0.05)。结论管型器械吻合法手术时间更短,手术切口较之传统开腹手术也较小,具有腹腔镜协助手术的直观、清晰的优点,同时兼顾直视下操作的便捷性、安全性,是一种值得提倡的手术方式。Objective To introduce the operation process of laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction,and evaluate its feasibility,safety during perioperative period,and advantages of anastomosis.Methods A total of 56 patients with gastric cancer who underwent laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction were selected as study subjects from Zhejiang Provincial People′s Hospital between May 2022 and June 2023.Gender,age,body mass index(BMI),tumor location,tumor stage,tumor type and other related indicators were collected.The main parameters during the operation process were collected,including operation time,anastomosis time,intraoperative blood loss,postoperative recovery status,exhaust time,feeding time,complications related to anastomosis,and length of hospital stay.The differences between other digestive tract reconstruction methods such as Overlap method,reverse puncture method,and handmade anastomosis were compared and analyzed.Results A total of 56 patients with gastric cancer were included in this study.The anastomosis time of the tubular instrument group was(42.3±15.7)min,which was superior to the handmade anastomosis group(P<0.05).The operation time of the tubular instrument group was(176.3±25.8)min,which was superior to other methods(all P<0.05).The intraoperative blood loss of the tubular instrument group was(75.68±20.34)ml,which was less than other methods(all P<0.05).The exhaust time of the tubular instrument group was(2.6±0.2)d,which was similar to the Overlap method(P>0.05),but earlier than the handmade anastomosis method and the reverse puncture method(all P<0.05).The incidence of anastomotic leakage in the tubular instrument group was similar to the handmade anastomosis method,the reverse puncture method,and the Overlap method(all P>0.05).The

关 键 词：胃肿瘤 胃切除术 管型吻合 消化道重建 

分 类 号：R735.2[医药卫生—肿瘤]