腹腔镜胃切除后食管残胃和食管空肠吻合新技术  

New technique of esophagogastrostomy and esophagojejunostomy after laparoscopic gastrectomy

作　　者：柯重伟[1] 陈丹磊[1] 丁丹[1] 

机构地区：[1]第二军医大学附属长海医院微创外科,上海200433

出　　处：《中华消化外科杂志》2011年第3期191-195,共5页Chinese Journal of Digestive Surgery

摘　　要：目的探讨经口腔放置倾斜的圆形抵钉座（OrVil^TM装置）进行腹腔镜胃切除后食管残胃和食管空肠吻合的疗效。方法回顾性分析2009年7月至2011年2月第二军医大学附属长海医院收治的接受OrVil^TM装置在腹腔镜下进行消化道重建的34例胃肿瘤患者的临床资料。手术采用4孔法，在完成淋巴结清扫以及食管游离后，先横断食管；然后在食管断端开口，将含OrVil^TM装置的胃管从该开口穿出，并将抵钉座带入腹腔；最后在腹腔镜监视下，在体内完成食管残胃或食管空肠吻合。结果34例患者手术顺利，无中转开腹。其中32例经口腔放置0rVil^TM装置顺利；2例经口腔放置OrVil^TM装置困难，经放掉患者气管插管气囊内的气体并将其头部后仰后顺利放置。34例患者平均手术时间为175min（90～240min）；术中平均出血量为196ml（50～800m1）；术后平均住院时间为7．6d（5～14d）；术后胃肠功能平均恢复时间为3d（2～6d），并开始进食流质饮食和下床活动。术后未出现吻合口漏。33例患者获得随访，平均随访时间为（10±6）个月（2—20个月），无肿瘤复发和转移发生。结论OrVil^TM装置改变了以往抵钉座的置入方向，这一技术可以避免开胸手术，降低腹腔镜下消化道重建的操作难度，缩短手术时间。Objective To investigate the efficacy of transorally inserted anvil system （ OrVilTM ） in esophagogastrostomy and esophagojejunostomy after laparoscopic gastrectomy. Methods The clinical data of 34 patients with gastric neoplasms who were installed OrVilTM for esophagogastrostomy or esophagujejunostomy at the Changhai Hospital from July 2009 to February 2011 were retrospectively analyzed. After radical dissection of lymph nodes and full mobilization of esophagus, the esophagus was transected and the anvil was then transorally inserted into the esophagus by using the OrVilTM system. Double-stapling esophagogastrostomy or esophagojejunostomy with a circular stapler was performed intracorporeally under direct laparoscopie view. Results The surgery was success- fully completed in all the 34 patients with no conversion to open surgery. Two patients had difficulty in placing OrVil^TM system, and the condition was alleviated by reducing tension in the cuff and tilting the head back. The mean operation time, volume of blood loss, duration of postoperative hospital stay and time to gastrointestinal function recovery were 175 minutes （range, 90-240 minutes）, 196 ml （range, 50-800 ml）, 7.6 days （range, 5- 14 days） and 3 days （range, 2-6 days）. No postoperative anastomotic leakage was detected. Thirty-three patients were followed up for 2-20 months with a mean time of （ 10 ± 6） months, and no tumor recurrence or metastasis occurred. Conclusion OrVil^TM system changes insert direction of the anvil, which significantly reduces the difficulty of laparoscopic operation, shortens the operation time and avoids the thoracotomy.

关 键 词：胃肿瘤 腹腔镜检查 胃切除术 食管残胃吻合术 食管空肠吻合术 

分 类 号：R735.2[医药卫生—肿瘤]