反穿刺器在腹腔镜食管-残胃（空肠）吻合术中的应用  

Clinical application of reverse puncture device （RPD） in laparascopic esophagogastrectomy （esophagojejunostomy） ： a report of 18 cases

作　　者：陈丹磊[1] 丁丹[1] 柯重伟[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：《中华胃肠外科杂志》2013年第10期956-959,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨新型装置反穿刺器（RPD）在腹腔镜食管．残胃（空肠）吻合术中应用的可行性、安全性及临床效果。方法2010年8月至2011年10月，第二军医大学附属长海医院微创外科对14例胃癌及4例贲门胃肠间质瘤患者施行腹腔镜下食管．空肠（残胃）吻合术，即在腹腔镜下切开食管前壁，置人RPD，在切口上方3cm处自食管前壁穿出，紧贴切口上方切割闭合食管残端，完成抵钉座的放置，随后在上腹正中小切口辅助下进一步完成吻合。结果18例患者中男12例，女6例，年龄42～68（平均53）岁。全组患者均顺利完成手术，手术时间125～235（平均155）min，抵钉座的平均放置时间为12min，术中出血60—100（平均75）ml。患者均在术后第2-3d肛门排气，未发生吻合i21瘘、吻合口狭窄、腹腔感染等并发症，于术后7～13d出院，无围手术期死亡病例。术后随访11～25月，均无复发病例。结论利用RPD行食管．残胃（空肠）吻合术，可免去在食管进行荷包缝合的操作，且不需要麻醉师配合放置带抵钉座的胃管，更加简便安全。Objective The authors report the newly developed reconstruction technique after laparoscopic total gastrectomy （LTG） or laparoseopic distal gastrectomy （LDG）： intracorporeal circular stapling esophagojejunostomy （esophagojejunostomy） using the reverse puncture device （RPD）. Methods After LTG or LDG, The anvil is then transorally inserted into the esophagus by using the RPD system. Double-stapling esophagojejunostomy with a circular stapler is performed intracorporeally, and the jejunal stump is closed with an Echelon. Results There was no intraoperative complication or conversion to open surgery, the mean operation time was 155 min and blood loss was 75 ml. Postoperative fluorograpby revealed no anastomosis leakage or stenosis Patients resumed an oral liquid diet on postoperative day 2, and discharged at day 8. Conclusions We have successfully performed LTG or LDG, reconstruction using our technique in 18 patients without any anastomosis complications. We believe that our procedure is a safe and reliable reconstruction method, which is especially useful in obese patients, in whom conventional extracorporeal anastomosis is often difficult.

关 键 词：腹腔镜手术 反穿刺器 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]