Overlap引导管在腹腔镜全胃切除Overlap食管空肠吻合术中的应用价值  

Application value of Overlap guiding tube in Overlap esophagojejunostomy of laparoscopic total gastrectomy

作　　者：陈新华 胡彦锋[1] 林填[1] 陈豪[1] 陈韬[1] 赵明利[1] 钟晴蕾 卢逸菲 刘浩[1] 赵丽瑛[1] 黄慧琳 李国新[1] 余江[1] Chen Xinhua;Hu Yanfeng;Lin Tian;Chen Hao;Chen Tao;Zhao Mingli;Zhong Qinglei;Lu Yifei;Liu Hao;Zhao Liying;Huang Huilin;Li Guoxin;Yu Jiang(Department of General Surgery&Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;The First School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院普通外科,广东省胃肠肿瘤精准微创诊疗重点实验室,广州510515 [2]南方医科大学第一临床医学院,广州510515

出　　处：《中华消化外科杂志》2022年第1期99-105,共7页Chinese Journal of Digestive Surgery

基　　金：广东省胃肠肿瘤精准微创诊疗重点实验室(2020B121201004);南方医科大学南方医院临床研究专项(2021CR001);广东省省级科技计划项目(2017B020226005);2021年广东省科技创新战略专项资金重点项目(pdjh2021a0092,pdjh2021a0093);2021年大学生创新创业训练项目(202112121019);广东省重大人才工程(2019JC05Y361)。

摘　　要：目的探讨Overlap引导管(OGT)在腹腔镜全胃切除Overlap食管空肠吻合术中的应用价值。方法采用回顾性描述性研究方法。收集2021年6—7月南方医科大学南方医院收治的5例胃癌患者的临床资料;男3例,女2例;中位年龄为54岁,年龄范围为48~61岁。患者均行腹腔镜全胃切除联合OGT引导Overlap食管空肠吻合术。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊和电话方式进行随访,了解患者术后吻合口狭窄及食管反流情况。随访时间截至2021年9月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(IQR)或M(范围)表示。计数资料以绝对数表示。结果(1)手术情况:5例患者均顺利完成腹腔镜全胃切除联合OGT引导Overlap食管空肠吻合术,均行D2淋巴结清扫,均获得R0切除,无联合脏器切除、无中转开腹和(或)中转联合开胸、无中转其他食管空肠吻合方式。5例患者肿瘤长径为3.0(2.8)cm,切口长度为5.0(2.0)cm,清扫淋巴结数目为47.0(21.0)枚,食管空肠吻合时间为21.0(5.0)min,消化道重建时间为62.0(23.0)min,手术时间为295.0(75.0)min,术中出血量为50.0(60.0)mL。5例患者中,4例钉砧置入食管腔一次性成功,1例经2次钉砧置入食管腔操作完成食管空肠吻合。(2)术后情况:5例患者术后首次下床活动时间为2.0(1.0)d,首次肛门排气时间为3.0(2.0)d,首次进食全流质食物时间为4.0(3.0)d,首次进食半流质食物时间为6.0(3.0)d,拔除腹腔引流管时间为7.0(4.0)d,住院时间为9.0(6.0)d。5例患者术后组织病理学检查结果均为胃腺癌,分期为pT2~4aN0M0期;食管切缘均为阴性,食管近切缘距离为5.0(4.0)cm。5例患者术后均无吻合口漏、吻合口出血、吻合口狭窄,2例发生轻度(Clavien-DindoⅡ级)肺炎,经抗感染、促进排痰等保守治疗后均痊愈。无非计划二次手术、无围手术期死亡病例。(3)随访情况:5例患者均获得随访,随访时间为术后3个月。Objective To investigate the application value of Overlap guiding tube(OGT)in Overlap esophagojejunostomy of laparoscopic total gastrectomy.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 5 patients with gastric cancer who were admitted to Nanfang Hospital of Southern Medical University from June to July in 2021 were collected.There were 3 males and 2 females,aged from 48 to 61 years,with a median age of 54 years.Patients underwent laparoscopic total gastrectomy combined with OGT-assisted Overlap esophagojejunostomy.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)follow-up.Follow-up was conducted by outpatient examination and telephone interview to detect postoperative anastomotic stenosis and esophageal reflux up to September 2021.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(IQR)or M(range).Count data were represented as absolute numbers.Results(1)Surgical situations:5 patients underwent laparoscopic total gastrectomy combined with OGT-assisted Overlap esophagojejunostomy and D2 lymph node dissection success-fully,achieving R0 resection.There was no combined organ resection,intraoperative conversion to laparotomy or combined thoracotomy.There was no intraoperative conversion to other esophagoje-junostomy method either.The tumor diameter,length of surgical incision,the number of lymph nodes dissected,time of esophagojejunal anastomosis,time of digestive reconstruction,operation time,volume of intraoperative blood loss of 5 patients were 3.0(2.8)cm,5.0(2.0)cm,47.0(21.0),21.0(5.0)minutes,62.0(23.0)minutes,295.0(75.0)minutes,and 50.0(60.0)mL,respectively.The anvil fork of linear stapler was successfully inserted into esophageal lumen by once operation in 4 cases of 5 patients and by twice operation in 1 case to complete the esophagojejunostomy.(2)Post-operative situations:the time to first out-of-bed activities,time to postoperative first anal flatus

关 键 词：胃肿瘤 胃上部 全胃切除术 Overlap吻合 Overlap引导管 腹腔镜检查 

分 类 号：R735.2[医药卫生—肿瘤]