改良捆绑式反穿刺法食管空肠吻合术在腹腔镜根治性全胃切除术中的应用研究  

Application of modified bundled reverse puncture esophagojejunostomy in laparoscopic radical total gastrectomy

作　　者：李胜 杨文光 张仲良 何玉奇 Li Sheng;Yang Wenguang;Zhang Zhongliang;He Yuqi(General Surgery,Lanzhou First People's Hospital,Lanzhou730050,China;Surgical Oncology,Lanzhou First People's Hospital,Lanzhou730050,China;The Second Department of General Surgery,Jinchang Hospital of Integrated Traditional Chinese and Western Medicine,Jinchang 737100,Gansu,China)

机构地区：[1]兰州市第一人民医院普外科,甘肃兰州730050 [2]兰州市第一人民医院肿瘤外科,甘肃兰州730050 [3]甘肃省金昌市中西医结合医院普外二科,甘肃金昌737100

出　　处：《兰州大学学报（医学版）》2024年第3期49-55,共7页Journal of Lanzhou University（Medical Sciences）

基　　金：甘肃省科技厅民生科技专项-社会发展专题资助项目(21CX6NC228)。

摘　　要：目的 探讨改良捆绑式反穿刺法食管空肠吻合术在腹腔镜根治性全胃切除术中的临床应用价值。方法 选取182例腹腔镜根治性全胃切除术中使用改良捆绑式反穿刺法食管空肠吻合术患者,以自制带牵引线的橡皮筋将空肠和吻合器捆绑固定,采用常规反穿刺法与食管端侧吻合,完成食管空肠吻合,观察其临床治疗效果。结果 182例患者均顺利完成手术,无中转开腹。手术时间(196.2±22.4)min,切口长度(3.89±1.23)cm;食管近缘长度(3.78±0.56)cm;抵钉座置入时间(9.20±2.40)min,术中出血量(56.20±22.40)mL;术后吻合口漏3例,吻合口出血3例,切口感染2例,吻合口狭窄5例;所有患者均随访8~36个月,平均20.6个月,吻合口复发2例,其余未见肿瘤局部复发。结论 在腹腔镜根治性全胃切除术中,改良后的捆绑式反穿刺吻合技术具备一定的安全性和可行性,临床疗效显著,具有临床推广价值。Objective To investigate the clinical value of modified bundled reverse puncture esophagojejunostomy in laparoscopic radical total gastrectomy.Methods A total of 182 patients underwent laparoscopic radical total gastrectomy using the modified bundled reverse puncture method for esophagojejunostomy.The jejunum and stapler were securely fastened with a self-made rubber band sequipped with traction lines,while the end-to-side anastomosis of the esophagus was performed using the conventional reverse puncture method to accomplish the esophagojejunostomy.The clinical indicators were subsequently observed.Results All 182 cases were successfully completed with no intermediate openings.Operation time(196.2±22.4)min;incision length(3.89±1.23)cm;length of proximal esophagus(3.78±0.56)cm;nailseat placement time(9.20±2.40)min;intraoperative bleeding volume(56.20±22.40)mL.There were 3 cases of postoperative anastomotic leakage,3 cases of anastomotic bleeding,2 cases of incisional infection,and 5 cases of anastomotic stenosis;182 cases were followed up for 8 to 36 months,with an average of 20.6 months,with 2 cases having had anastomotic recurrence.Conclusion The modified bundled reverse puncture anastomosis technique demonstrates notable safety and feasibility in laparoscopic radical total gastrectomy,with significant clinical efficacy,thereby warranting its widespread adoption inclinical practice.

关 键 词：胃癌 改良捆绑式反穿刺法 食管-空肠吻合 腹腔镜 根治性全胃切除术 

分 类 号：R735.2[医药卫生—肿瘤]