完全腹腔镜全胃切除食管空肠吻合手术方式选择思考:手工缝合与器械吻合的碰撞与融合  

The methods of anastomosis in totally laparoscopic total gastrectomy esophagojejunostomy-the collision and fusion of hand suturing and stapled anastomosis

作　　者：邱江锋[1] 曹晖[1] Qiu Jiangfeng;Cao Hui(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127

出　　处：《中华消化外科杂志》2023年第10期1194-1198,共5页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82072669)。

摘　　要：完全腹腔镜全胃切除术是胃外科技术要求最高的手术,既需要在腹腔镜下完成全胃切除及淋巴结清扫,还需要在腹腔镜下完成消化道重建,其中腹腔镜下食管空肠吻合是技术难点。目前常用的吻合方式包括管状吻合、直线切割吻合以及手工缝合3类,但如何合理、安全选择吻合方式仍存较大争议。笔者结合团队经验,回顾器械吻合和手工缝合的进展,深入阐述在全腹腔镜时代胃外科医师根据个人腔镜技术能力、器械及患者条件选择合适的食管空肠重建方式,力求以最小的创伤达到最佳的精准、微创效果。Totally laparoscopic total gastrectomy is the most comlex procedure in gastric surgery,which involves the entire stomach removal,lymph node dissection and digestive tract recons-truction through minimally invasive techniques,among which laparoscopic esophagojejunostomy is a technological difficulty.Currently,three types of anastomoses are widely used,including stapled anastomosis with circular staplers or linear staplers,and hand suturing,but which is the best and safe anastomosis remains controversial.Based on team experience,the authors review the progress of esophagojejunostomy on stapled anastomosis or hand suturing,promote that how to select an appropriate esophagojejunostomy according to surgeon′s individual technical capabilities,operating habits and patient conditions,strive to achieve the precise and minimally invasive effect with the least trauma for patients.

关 键 词：胃肿瘤 全胃切除术 完全腹腔镜 消化道重建 食管空肠吻合 器械吻合 手工缝合 

分 类 号：R735.2[医药卫生—肿瘤]