腔镜用缝合器在腹腔镜下胃空肠吻合中的应用  

Application of endoscopic suturing instrument in laparoscopic gastrojejunostomy

作　　者：张波 周帅 何显力 Zhang Bo;Zhou Shuai;He Xianli(Department of General Surgery,The Second Affiliated Hospital,Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学第二附属医院普通外科,西安710038

出　　处：《中华胃肠外科杂志》2023年第4期380-382,共3页Chinese Journal of Gastrointestinal Surgery

基　　金：陕西省重点产业创新链(群)⁃社会发展领域(2022ZDLSF04⁃05);空军军医大学第二附属医院(唐都医院)学科平台提升计划项目(2020XKPT010)。

摘　　要：目的探讨腔镜用缝合器在腹腔镜下胃空肠吻合中应用的安全性与可行性。方法采用描述性病例系列研究方法,回顾性分析2022年10月至2023年1月期间,空军军医大学第二附属医院实施的5例腹腔镜远端胃癌根治术(BillrothⅡ+Braun吻合)中应用腔镜用缝合器缝合关闭胃空肠共同开口患者的病例资料。手术适应证为:(1)年龄为18~75岁;(2)术前病理确诊为胃腺癌;(3)术前临床分期为Ⅰ~Ⅲ期;(4)肿瘤位于胃中下1/3处,可行根治性远端胃切除术;(5)既往无上腹部手术史(腹腔镜胆囊手术除外)。手术步骤如下:在进行胃-空肠吻合时,先以腔镜下直线切割闭合器进行胃空肠侧侧吻合,然后以腹腔用缝合器缝合关闭共同开口。在缝合关闭共同开口时,采用自下而上、先内进内出后垂直褥式缝合的方法,实现胃壁与空肠壁黏膜-黏膜、浆膜-浆膜完整内翻闭合;第一层缝合结束后,再自上而下行浆肌层缝合包埋胃空肠共同开口。结果5例患者均顺利完成了腹腔镜下利用腔镜用缝合器关闭胃空肠共同开口。手术时间(308.6±22.6)min;胃空肠吻合时间(15.4±3.1)min;术中出血量(34.0±10.8)ml。均无术中或术后并发症发生,术后肛门排气时间(2.6±0.9)d,术后住院天数(7.0±1.9)d。结论腔镜用缝合器在腹腔镜应用于进行胃空肠吻合中安全可行。Objective To investigate the safety and feasibility of using an endoscopic suturing instrument in laparoscopic gastrojejunostomy.Methods A descriptive case series study was conducted to retrospectively analyze the clinical data of 5 patients with gastric cancer who underwent laparoscopic distal gastrectomy(Billroth II+Braun anastomosis)at Tangdu Hospital,Air Force Medical University from October 2022 to January 2023.The common opening was closed using an endoscopic suturing instrument.The indications were as follows:(1)patients aged between 18 and 80 years;(2)patients with gastric adenocarcinoma;(3)cTNM between I-III;(4)lower-third gastric cancer and radical gastrectomy is recommended;(5)no history of upper abdominal surgery(except for laparoscopic cholecystectomy).The surgery was performed as follows:A side-to-side gastrojejunostomy was performed with endoscopic linear cutter stapler.Then the common opening was closed with endoscopic suturing instrument.During suturing and closing the common opening,a vertical mattress suture was used to completely invert and close the mucosa-to-mucosa and serosa-to-serosa of the gastric and jejunum walls.After the first layer of suture was completed,the seromuscular layer was sutured from top to bottom to embed the common opening of stomach and jejunum.Results Laparoscopic closure of the common gastrojejunal opening with endoscopic suturing instrument was successfully completed in all 5 patients.The operative time was(308.6±22.6)minutes,while the time of gastrojejunostomy was(15.4±3.1)minutes.The operative blood loss was(34.0±10.8)ml.No intraoperative or postoperative complications occurred in any of the patients.The first passage of gas occurred at(2.6±0.9)days,and the postoperative hospital stay was(7.0±1.9)days.Conclusion The application of endoscopic suturing instrument in laparoscopic gastrojejunostomy is safe and feasible.

关 键 词：胃肿瘤 腔镜用缝合器 BillrothⅡ式吻合 腹腔镜 胃切除术 

分 类 号：R656[医药卫生—外科学]