腹腔镜下近端胃切除λ型改良双通道重建初步应用结果  

Preliminary application results of laparoscopic assisted proximal gastrectomyλ-shaped double tract anastomosis

作　　者：王森 王林俊[1,2] 周杰 李沣员[1,2] 葛晗 张殿彩 徐皓 徐泽宽 Wang Sen;Wang Linjun;Zhou Jie;Li Fengyuan;Ge Han;Zhang Diancai;Xu Hao;Xu Zekuan(Gastric Cancer Center,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of General Surgery,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Anesthesiology and Surgery,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Institute for Gastric Cancer Research,Nanjing Medical University,Nanjing 211166,China;Jiangsu Key Lab of Cancer Biomarkers,Prevention and Treatment,Collaborative Innovation Center for Personalized Cancer Medicine,Nanjing Medical University,Nanjing 211166,China)

机构地区：[1]南京医科大学第一附属医院胃肿瘤中心,南京210029 [2]南京医科大学第一附属医院普通外科,南京210029 [3]南京医科大学第一附属医院麻醉手术科,南京210029 [4]南京医科大学胃癌研究所,南京211166 [5]江苏省肿瘤生物标志物及防治重点实验室南京医科大学肿瘤个体化医学协同创新中心,南京211166

出　　处：《中华胃肠外科杂志》2024年第10期1038-1044,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(82072708、82273038、82202849)。

摘　　要：目的分析“λ型改良双通道法”吻合进行腹腔镜辅助近端胃切除后消化道重建的结果。方法采用回顾性描述性研究方法。2024年1月期间,南京医科大学第一附属医院胃肿瘤中心对收治的3例原发性胃恶性肿瘤患者采用λ型改良双通道法在腹腔镜辅助近端胃切除术中进行消化道重建。具体操作:完成近端胃切除后,在距Treitz韧带约15 cm处切断空肠。距远端空肠18~20 cm处,缝线标记食管空肠吻合口,经远端空肠置入24号吻合器钉座,空肠残端转向右侧,在18~20 cm标记处穿出吻合钉行食管空肠端-侧管型吻合,食管空肠吻合口以倒刺线连续缝合加强,60 mm直线切割闭合器闭合空肠残端。于残胃前壁中部予以缝线标记胃空肠吻合口胃侧,于远端空肠距离残端约2 cm处及8 cm处标记胃空肠吻合口空肠侧,以电刀分别开约0.5 cm开口,使用60 mm直线切割闭合器按照标记行残胃前壁空肠侧侧吻合术,使食管空肠吻合至胃空肠吻合距离为10~12 cm,倒刺线关闭共同开口。距食管空肠吻合口下方约50 cm处小肠开口与近端空肠以管型吻合器行侧-侧吻合,3-0薇荞关闭共同开口,完成λ型改良双通道重建。分析手术及术后情况,包括手术时间、吻合时间、术中出血量、肿瘤大小和病理、术后下床、通气和进水时间、出院时间、术后并发症情况、术后胃肠道造影以观察食物通过胃袢及肠袢情况。结果3例患者顺利完成腹腔镜辅助近端胃切除改良λ型改良双通道吻合术。手术时间分别为155 min、240 min和160 min;术后下床时间分别为20 h、18 h和26 h,通气时间分别为59 h、83 h和75 h,饮水时间分别为66 h,87 h和90 h;术后出院天数均为7 d;均无手术相关并发症发生。术后第6天及术后3个月行消化道造影复查,造影剂均可顺利通过空肠袢和残胃-空肠袢,双侧均通畅,并未见造影剂逆行至食管空肠吻合口。结论腹腔镜辅助近端胃�Objective To share the results of laparoscopic assisted proximal gastrectomyλ-shaped modified double tract reconstruction.Method This study retrospectively included 3 patients during January 2024 from the Department of Gastric Surgery at the First Affiliated Hospital of Nanjing Medical University using theλ-shaped modified double tract reconstruction.The procedure of theλ-shaped modified double tract reconstruction is as follows.After completing proximal gastrectomy,the jejunum is transected 15 cm from the Treitz ligament.A suture is made 18-20 cm from the distal jejunum to mark the esophagojejunal anastomosis site.A circular stapler anvil is inserted through the distal jejunum,and the remaining end of the jejunum is turned to the right.The circular stapler is pierced through the marked site for an esophagojejunal end-to-end anastomosis,which is reinforced with a barbed suture continuously.A 60mm linear stapler is used to close the remaining end of the jejunum.We then mark the gastric side of the gastrojejunal anastomosis with suture in the middle of the anterior wall of the residual stomach,and mark the jejunal side of the gastrojejunal anastomosis at a distance of about 2 cm and 8 cm from the residual end of the distal jejunum.We make an opening of about 0.5 cm and use a 60 mm linear stapler to perform anastomosis on the jejunal side of the anterior wall of the residual stomach according to the markings,so that the distance between the esophagojejunal anastomosis and the gastrojejunal anastomosis is 10-12 cm.The common opening is closed with barbed wire.About 50 cm below the esophagojejunal anastomosis,the small intestine opening is anastomosed side to side using a circular stapler and the common opening is closed.Return the jejunum into the abdominal cavity to complete the reconstruction of theλ-shaped double tract reconstruction.We analyzed the surgery and postoperative conditions,including surgery time,anastomosis time,intraoperative bleeding,tumor size and pathology,postoperative mobilization,passage of

关 键 词：胃肿瘤 近端胃切除术 λ型改良双通道吻合 

分 类 号：R735.2[医药卫生—肿瘤]