完全腹腔镜全胃切除胃癌根治术消化道重建方式的探讨  

Exploration of digestive tract reconstruction with totally ;laparoscopic total gastrectomy for gastric cancer

作　　者：邹镇洪[1] 牟廷裕[1] 邓镇威 江玉明[1] 李国新[1] 

机构地区：[1]南方医科大学南方医院普通外科,广州510515

出　　处：《中华胃肠外科杂志》2014年第8期844-847,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：与腹腔镜辅助的胃癌根治术相比较，完全腹腔镜胃癌根治术在全腔镜下行消化道重建，切口更小，拥有更佳的观察和操作视野，且对于病灶较大、位置较高及肥胖患者仍然适用。近期，一些学者进行了全腹腔镜下胃癌根治术消化道重建方式的尝试，但何种术式更佳尚存在诸多争议。本文综述了目前全腹腔镜全胃切除胃癌根治术腔内吻合方式的进展，着重于介绍其重建技巧及适应证。目前报道的全腹腔镜全胃切除胃癌根治术行消化道重建均是采用食管空肠Roux-en-Y吻合，而实现食管空肠Roux-en-Y吻合的重建技术各有利弊。术者应根据肿瘤位置、食管管径大小及个人特长等情况选择，以期患者最大获益。Compared to that with laparoscopic assisted approach, intracorporeal anastomosis with totally laparoscopic radical total gastrectomy has the advantages of smaller incision, and better vision for operation, and may also be fit for patients with large size lesion, high-located lesions, or obesity. It remains controversial though several surgeons have reported the safety and feasibility of intracorporeal anastomosis with totally laparoscopic total gastrectomy. This review describes the recent technical advances in intracorporeal anastomoses with totally laparoscopic total gastrectomy, focusing on the reconstruction skills and indications. Current data on totally laparoscopic total gastric resection for gastric carcinoma revealed that all digestive tract reconstructions were performed with esophagus-jejunum Roux-en-Y anastomosis, and different reconstruction techniques of such Roux-en-Y anastomosis have certain advantages and disadvantages. Surgeons should make choice based on tumor location,esophageal diameter and personal skills in order to achieve maximal benefit to patients.

关 键 词：胃肿瘤 腹腔镜 腔内吻合 消化道重建 全胃切除术 

分 类 号：R735.2[医药卫生—肿瘤]