热点聚焦——完全腹腔镜全胃切除食管空肠吻合路在何方?  

Exploration of esophagojejunostomy after totally laparoscopic total gastrectomy

作　　者：黄华[1] 臧明德 张钰 陈杰 Huang Hua;Zang Mingde;Zhang Yu;Chen Jie(Department of Gastric Surgery,Cancer Hospital of Fudan University Department of Oncology,Fudan University Shanghai Medical College,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院胃外科复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中华胃肠外科杂志》2023年第1期27-32,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(82273181)。

摘　　要：完全腹腔镜全胃切除在淋巴结清扫方面的优势似乎越来越被业界认可。全胃切除后消化道重建,既是难点,也是争论的焦点和研究的热点。采取何种方式实施食管空肠吻合,使用管型吻合器、还是使用线型切割缝合器,何种方法更佳,这些都是亟待回答的问题。完全腹腔镜全胃切除食管空肠吻合路在何方?笔者认为,在现有吻合器械的条件下,使用线型切割缝合器行食管空肠侧侧吻合,完成完全腔镜全胃切除的消化道重建,可能是最常用的选择,但这一吻合方式尚存诸多问题,因此需严格掌握适应证。相信,随着适用于完全腹腔镜下食管空肠吻合的管型吻合器的研发取得突破,管型吻合器用于完全腔镜全胃切除消化道重建必将重新成为主流。基于此,目前临床常规开展完全腹腔镜全胃切除应持较为审慎的态度,应结合患者和医者的具体情况,做到有所为、有所不为。The advantages of lymph node dissection through total laparoscopic total gastrectomy(TLTG)seem to be more and more accepted by the academic community.However,reconstruction of digestive tract is challenging and remains a focus of debate and research.Which way is better for esophagojejunostomy,circular stapler or linear stapler,remains to be answered.The authors believe that,under the conditions of existing anastomosis instruments,using of linear stapler for esophagojejunal side-to-side anastomosis may be the most common choice,but it must be used with strict indications,because there are still many problems to be solved.It is believed that with the breakthrough in the development of the circular stapler suitable for esophagojejunostomy in TLTG,the application of circular stapler for digestive tract reconstruction will become the mainstream again in future.Thus,the current routine clinical practice of TLTG should be cautious and the surgical indications should be strictly evaluated.

关 键 词：全胃切除术 腹腔镜 食管空肠吻合术 管型吻合器 线型吻合器 

分 类 号：R656.61[医药卫生—外科学]