非离断式Roux-en-Y吻合在完全腹腔镜根治性全胃切除术重建中的应用  

The research on the application of uncut Roux-en-Y esophagojejunostomy in the digestivereconstruction after totally laparoscopic total gastrectomy

作　　者：洪强[1] 蔡秀军[1] 汪勇[1] 梁岳龙[1] 樊潇霄 Hong Qiang;Cai Xiujun;Wang Yong;Liang Yuelong;Fan Xiaoxiao(Department of General Surgery,Sir Run Run Shaw Hospital,Medical College of Zhejiang University,Hangzhou 310016,China)

机构地区：[1]浙江大学附属邵逸夫医院普外科,杭州310016

出　　处：《中华医学杂志》2018年第28期2254-2257,共4页National Medical Journal of China

基　　金：浙江省科技计划项目（2017C33094）

摘　　要：目的探讨非离断式Roux－en－Y吻合术应用于完全腹腔镜根治性全胃切除术消化道重建中的安全性及可行性。方法回顾性分析2016年7至11月浙江大学附属邵逸夫医院收治的15例胃癌患者的临床资料，15例患者均行完全腹腔镜下根治性全胃切除＋非离断式食管空肠Roux－en－Y吻合术，观察术中、术后及随访指标。结果15例胃癌患者其中胃体癌10例、食管胃结合部癌5例（SiewertⅡ型2例和SiewertⅢ型3例）。全组患者手术总时间（257.6±29.1） min，消化道重建时间（25.0±4.3） min，术中出血（133.3±121.2） ml，全组未出现术中大出血，无中转开腹病例。患者均术后第1天下床活动，术后首次肛门排气时间（4.1±0.8）d，术后首次进流质时间（5.1±0.9）d，术后住院时间（9.3±1.6）d。术后病理分型3例高分化腺癌、7例低分化腺癌、2例印戒细胞癌、1例黏液腺癌、2例神经内分泌癌；病理分期：Ⅰb期1例、Ⅱa期3例、Ⅱb期2例、Ⅲb期3例、Ⅲc期6例；淋巴结清扫数目（36.0±12.3）枚；上切缘均为阴性。全组无围手术期死亡，无吻合口漏及出血等相关并发症，术后1例患者肺部感染，经抗感染后治愈。随访发现1例术后8个月出现肝内转移，带瘤生存，1例出现吻合口复发，除吻合口复发患者外未见吻合口狭窄及阻断部位再通；未出现明显Roux－en－Y滞留综合征患者。结论非离断式Roux－en－Y吻合用于完全腹腔镜根治性全胃切除术的消化道重建中是安全可行的。ObjectiveTo evaluate the safety and flexibility of uncut Roux-en-Y esophagojejunostomy in totally laparoscopic total gastrectomy （TLTG）.MethodsBetween July 2016 to November 2016, 15 patients received totally laparoscopic total gastrectomy plus uncut Roux-en-Y esophagojejunostomy in the Sir Run Run Shaw hospital. Clinical data of those patients, including operative indexes, post-operative indexes and fellow-up data, were analyzed respectively.ResultsA total of 15 patients were enrolled in this study, ten were corpus carcinoma and five were esophagogastric junction carcinoma. The total operative time and anastomosis time was （25.0±4.3） min and （25.0±4.3） min, the blood loss during operation was （133.3±121.2） ml. All the operations were performed successfully, and no one was transferred to open surgery. All the patients were encouraged to off-bed activity at first day after surgery. The first time to flatus, the first time to liquid food intake and the length of stay in hospital were （4.1±0.8） days, （5.1±0.9） days and （9.3±1.6） days, respectively. The pathological staging of these patients was stage Ⅰb in 1 case, stage Ⅱa in 3 cases, stageⅡb in 2 cases, stage Ⅲb in 3 cases, stage Ⅲc in 6 cases. The lymph node harvest was （36.0±12.3）. Cutting margins in all patients were negative. Pulmonary infection occurred in one patient postoperatively and recovered after antibiotic treatment. No death and severe complication was found. Liver metastasis occurred in one patient eight months after operation. One patient was found recurrence in anastomotic site. No Roux-en-Y stasis syndrome was found.ConclusionsUncut Roux-en-Y esophagojejunostomy in TLTG is safe and flexible.

关 键 词：胃肿瘤癌 腹腔镜 全胃切除术 非离断式Roux-en-Y吻合术 

分 类 号：R735.2[医药卫生—肿瘤]