腹腔镜全胃切除食管空肠圆形吻合的新探索:线性自动荷包制作器联合密封盖通道技术  

A novel exploration of circular-stapled esophagojejunostomy in totally laparoscopic total gastrectomy:purse-string suture device with multi-functional seal cap

作　　者：杜建军[1] 赵立志[2] 蒋浩海 刘俊杰[1] Du Jianjun;Zhao Lizhi;Jiang Haohai;Liu Junjie(Department of General Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Gastrointestinal Surgery,Hanzhong City Centre Hospital,Hanzhong 723000,China;Department of Gastrointestinal Surgery,the First People's Hospital of Yancheng,Yancheng 224001,China)

机构地区：[1]复旦大学附属华山医院普通外科,上海200040 [2]陕西省汉中市中心医院消化外科,汉中723000 [3]江苏省盐城市第一人民医院胃肠外科,盐城224001

出　　处：《中华胃肠外科杂志》2025年第2期195-197,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨线性自动荷包制作器联合密封盖通道技术行腹腔镜全胃切除食管空肠吻合的安全性及可行性。方法本技术采用镜下线性自动荷包制作器联合多功能密封盖通道技术。行腹腔镜下D2淋巴清扫加全胃切除术后, 将线性自动荷包制作器通过多功能密封盖自由进入腹腔, 放置于食管合适位置成功击发后, 完成食管荷包制作。荷包内置入钉砧头, 25 mm管状吻合器通过多功能密封盖进入腹腔, 镜下进行食管空肠端-侧圆形吻合重建。结果 2024年11—12月间, 3例胃癌患者接受腹腔镜D2淋巴清扫全胃切除手术并顺利完成基于线性自动荷包制作器联合密封盖通道技术的食管空肠圆形吻合重建, 手术时间分别为180、260和240 min, 钉砧头置入食管时间分别为4.0、4.0和4.5 min, 出血量均分别为100 ml。食管切缘距肿瘤均分别为2 cm, 切缘均阴性无肿瘤。术后口服造影吻合口未见造影剂外渗。3例患者术后分别随访33、30和25 d, 均未发现吻合口出血和吻合口漏等相关并发症。结论镜下自动荷包制作器联合密封盖通道腔镜外科技术, 安全可行, 有望成为腹腔镜胃癌根治全胃切除食管空肠圆形吻合重建新的选择。Objective To explore the safety and feasibility of circular-stapled anastomosis using purse-string suture device with multi-functional seal cap in totally laparoscopic total gastrectomy esophagojejunostomy.Methods This technique is based on a new purse-string suture device and multi-functional seal cap.After laparoscopic total gastrectomy and D2 dissection,the purse-string suture device was inserted into the abdominal cavity through the multi-functional sealing cover and placed in a proper position along the distal esophagus for formation of purse-string suture.Anvils were introduced inside the purse-string after its fire,and a 25-mm cicular stapler was inserted to the abdominal cavity through the multi-functional seal cap,following laparoscopic end-to-side circular-stapled esophagojejunostomy.Results From November 2024 to December 2024,three patients with gastric cancer underwent laparoscopic total gastrectomy with D2 lymphadenectomy and successfully accepted laparoscopic esophagojejunostomy based on the purse-string suture device with multi-functional seal cap. The operation time was 180 minutes,260 minutes and 240 minutes, respectively with the time of anvil pacement of 4 minutes,4 minutes,4.5 minutes for the three cases. The bleeding volume of each was 100 ml respectively. The proximalesophageal margins were 2 cm from the tumor, and the margins were negative for tumor. Noextravasation of contrast agent was seen in the postoperative oral contrast anastomosis. All threepatients were followed up for 33, 30, and 25 days after the operation, and no anastomotic bleeding,leakage, or other related complications were found. Conclusion The circular anastomosis usingpurse-string suture device with multi-functional seal cap in totally laparoscopic total gastrectomyesophagojejunostomy is safe and feasible, which is a promising novel choice for laparoscopic radicaltreatment of gastric cancer with total gastrectomy oesophagojejunostomy.

关 键 词：胃肿瘤 消化道重建 腹腔镜手术 全胃切除术 

分 类 号：R73[医药卫生—肿瘤]