完全腹腔镜全胃切除术后食管空肠手工吻合重建消化道10例报告  

Hand-sewn esophagojejunostomy after total laparoscopic total gastrectomy:a case series of 10 consecutive patients

作　　者：孙蒙清 陈少博 何小东[1] 韩显林[1] SUN Meng-qing;CHEN Shao-bo;HE Xiao-dong(Department of General Surgery,Peking Unioi Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100005,China)

机构地区：[1]中国医学科学院北京协和医院基本外科,北京100005

出　　处：《中国实用外科杂志》2024年第8期927-931,共5页Chinese Journal of Practical Surgery

基　　金：中央高水平医院临床科研基金项目(No.2022-PUMCH-B-003)。

摘　　要：目的探讨完全腹腔镜全胃切除术(TLTG)后行食管空肠手工吻合重建消化道的临床应用价值。方法采用回顾性描述性研究方法。收集2021年9月至2024年1月北京协和医院收治的10例行TLTG+食管空肠手工吻合的胃癌或食管胃结合部癌病人的临床病理资料。统计入组病人的术中情况、术后恢复情况及术后病理学检查结果。结果(1)所有纳入病人男8例,女2例,年龄(62.6±6.4)岁。术中情况:手术时间(234.2±55.1)min,术中出血量100(50~800)m L,吻合时间(40.4±7.5)min。1例病人术中输红细胞400 mL,余9例病人术中未输血。无病人中转开放手术。(2)术后情况:3例病人返重症监护病房监护1 d;10例病人的术后胃管留置时间(2.9±0.9)d,首次喝水为术后第(2.9±1.3)d,首次进流食为术后第(5.6±0.8)d,平均在术后第(7.8±1.5)d拔除所有腹腔引流管。术后住院时间(11.6±3.4)d。未出现吻合口漏、吻合口出血、吻合口狭窄等并发症。(3)术后病理检查结果:高分化腺癌1例,高-中分化腺癌1例,中分化腺癌4例,低分化腺癌1例,印戒细胞癌2例,中-低分化鳞癌1例。TNM分期方面,ⅠA期3例,ⅠB期3例,ⅡA期2例,ⅢB期2例。平均淋巴结清扫个数(29.4±11.4)枚。7例病人无淋巴结转移。3例淋巴结转移者,转移个数6(2~10)枚。所有病人的食管断端切缘病理检查结果均为阴性,均为R0切除。结论对熟练掌握腔镜缝合技术的术者而言,TLTG食管空肠手工吻合安全、可行,有一定临床应用价值。Objective To investigate the clinical value of laparoscopic hand-sewn esophagojejunal anastomosis after totally laparoscopic total gastrectomy(TLTG).Methods A retrospective descriptive study was conducted.Clinical and pathological data of 10 patients with gastric cancer or esophago gastric junction cancer who underwent TLTG and hand-sewn esophagojejunal anastomosis at Peking Union Medical College Hospital from September 2021 to January 2024 were collected.The intraoperative condition,postoperative recovery and postoperative pathological examination results of the enrolled patients were counted.Results(1)There were 8 males and 2 females,with an average age of(62.6±6.4)years.Intraoperative data:The average operation time was(234.2±55.1)minutes,with a median intraoperative blood loss of 100(range 50-800)mL,and an average anastomosis time of(40.4±7.5)minutes.One patient received 400 mL of red blood cells intraoperatively,while the remaining 9 patients did not require blood transfusion.No patients required conversion to open surgery.(2)Postoperative data:Three patients were monitored in the ICU for 1 day;the postoperative gastric tube was retained for(2.9±0.9)days,with the first water intake occurring at(2.9±1.3)days postoperatively and the first liquid diet intake at(5.6±0.8)days postoperatively.On average,all abdominal drainage tubes were removed at(7.8±1.5)days postoperatively.The average length of postoperative hospital stay was(11.6±3.4)days.No anastomotic fistula,anastomotic bleeding,or anastomotic stenosis were observed.(3)Postoperative pathology:One case of well-differentiated adenocarcinoma,one case of moderately to well-differentiated adenocarcinoma,four cases of moderately differentiated adenocarcinoma,one case of poorly differentiated adenocarcinoma,two cases of signet ring cell carcinoma,and one case of moderately to poorly differentiated squamous cell carcinoma.In terms of TNM staging,there were 3 cases of stageⅠA,3 cases of stageⅠB,2 cases of stageⅡA,and 2 cases of stageⅢB.The average nu

关 键 词：食管空肠手工吻合 腹腔镜全胃切除术 胃癌 食管胃结合部癌 

分 类 号：R6[医药卫生—外科学]