自牵引后离断食管-空肠吻合术100例安全性评价  

Safety evaluation on initial 100 consecutive procedures of self-pulling and latter transected esophagojejunostomy

作　　者：蒿汉坤[1] 洪军[1] 王雅平[1] 王健[1] 贝一冰 华鲁纯[1] 

机构地区：[1]复旦大学附属华山医院普通外科,上海200040

出　　处：《中华胃肠外科杂志》2018年第2期206-211,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的评价自牵引后离断食管-空肠吻合（SPLT）在全腹腔镜全胃切除术（TLTG）中应用的安全性。方法2014年6月至2017年1月期间，在复旦大学附属华山医院普通外科接受TLTG-SPLT手术的100例患者（SPLT组）被纳入本研究，并以2013年10月至2015年12月同一手术团队实施的52例传统TLTG手术的患者作为对照（传统吻合组），回顾性分析两组患者的临床资料。所有患者均完成常规D2清扫，其中传统吻合组行常规Overlap或功能性端端吻合。SPLT组用第1枚钉仓离断十二指肠后，使用无菌麻绳对食管下段进行结扎，形成＂自牵引＂状态，对食管周围及其后方纵隔进行游离。于食管结扎线近端2~3 cm处右后壁打孔。取Treitz韧带远端约20 cm处小肠作为吻合肠袢，检查系膜张力后于对系膜缘肠壁打孔。使用第2枚钉仓完成食管右后壁与空肠对系膜缘的侧-侧吻合。以第3枚钉仓通过助手主操作孔在切除共同开口的同时，切断食管及近端空肠完成＂后离断＂。要求前后壁吻合线错开，完成一个三角形的食管-空肠吻合。取40 cm左右无功能袢，利用食管-空肠吻合的共同开口做空肠-空肠侧-侧吻合。以2枚ECR60W完成空肠-空肠吻合后即完成SPLT重建，标本置入标本袋后经延长的脐切口取出。比较两组患者术中情况、术后并发症发生率及术后恢复情况。结果两组患者一般资料具有可比性（均P 〉 0.05）。两组均顺利完成手术，无一例因吻合问题中转开腹，两组均未发现切缘阳性。SPLT组手术时间为（178.2 ± 35.9）min，其中吻合时间为（22.9 ± 7.1）min，均少于传统吻合组[分别为（204.4 ± 55.8）min和（30.5 ± 7.2）min]，差异均有统计学意义（P = 0.003，P = 0.000）。SPLT组术中出血量和术后首次排气时间分别为（74.3 ± 72.5）ml和（1.9 ± 1.6）d，少于传统吻合组的（104.2 ± 71.6）ml和（2.7 ± 1.3）d，差异有统ObjectiveTo evaluate the feasibility and the short-term safety of self-pulling and latter transected esophagojejunostomy （SPLT） in totally laparoscopic total gastrectomy （TLTG） .MethodsOne hundred patients with gastric cancer received TLTG-SPLT at General Surgery Department of Huashan Hospital （Fudan University） from June 2014 to January 2017 （SPLT group） . The clinicopathologic characteristics, surgical and postoperative outcomes were collected retrospectively and compared with the conventional group undergoing TLTG plus overlap or functional end-to-end anastomosis from October 2013 to December 2015. D2 lymph node dissection was regularly performed for all the patients. In SPLT group, a sterile hemp rope was held to ligate and drag down the esophagus to maintain ＂self-pulling＂ after the duodenum was transected by the first stapler, allowing the detachment of the posterior mediastinum. Then a hole 2-3 cm above the ligature rope was made on the right-posterior wall of the esophagus. When the mesenteric tension was checked, another hole was made at the anti-mesenteric border of the jejunum 20 cm distal to the ligament of Treitz. A side-to-side esophagojejunostomy （E-J） was then performed between the right-posterior wall of esophagus and the anti-mesenteric wall of the jejunum with the second linear stapler, forming an entry hole. The ＂latter transection＂ was applied with the third stapler inserted from the assistant′s Trocar, which facilitated the esophagus and the afferent loop jejunum to be simultaneously transected above the level of the entry hole. After that, a side-to-side jejunojejunostomy （J-J） with another 2 staplers was carried out between the afferent loop stump and the Roux limb 40 cm below E-J, in which the E-J entry hole could also work as the entrance for the stapler. The TLTG-SPLT was therefore completed and the specimen was removed through the incision from the umbilical Trocar site.ResultsThere were 66 male and 34 female patients in the SPLT group with median age

关 键 词：胃肿瘤 自牵引 后离断 食管-空肠吻合 全腹腔镜胃癌根治术 全胃切除术 

分 类 号：R735.2[医药卫生—肿瘤]