切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (04): 207 -211. doi: 10.3877/cma.j.issn.1674-6899.2020.04.004

所属专题： 文献资源库；

论著 上一篇    下一篇

系膜离断食管空肠π形吻合在全腹腔镜全胃切除术中的应用体会
朱初明 1, 姚国忠 1, 杨力 2 , †( ), 范浩 3, 张洪志 1, 吴建军 1, 晏江 1   
  1. 1. 213300 溧阳，江苏省人民医院溧阳分院普外科
    2. 213300 溧阳，江苏省人民医院溧阳分院普外科；210029 南京医科大学第一附属医院普通外科
    3. 210029 南京医科大学第一附属医院普通外科
  • 收稿日期:2020-05-10 出版日期:2020-08-30
  • 通信作者: 杨力
  • 基金资助:
    国家自然科学基金(81874219); 溧阳市科技计划项目(LC2019002)

Application of the mesentery transected π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy

Chuming Zhu 1, Guozhong Yao 1, Li Yang 2 , †( ), Hao Fan 3, Hongzhi Zhang 1, Jianjun Wu 1, Jiang Yan 1   

  1. 1. Department of General Surgery, Liyang People’s Hospital, Liyang Branch Hospital of Jiangsu Province Hospital, Liyang 213300, China
    2. Department of General Surgery, Liyang People’s Hospital, Liyang Branch Hospital of Jiangsu Province Hospital, Liyang 213300, China.; Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
    3. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2020-05-10 Published:2020-08-30
  • Corresponding author: Li Yang
  • About author:
    Corresponding author: Yang Li, Email:
全文 ( ) 下载PDF ( )
目的

探讨系膜离断食管空肠π形吻合在腹腔镜全胃切除术中应用的安全性和可行性。

方法

采用回顾性分析，收集2018年10月至2019年12月江苏省人民医院溧阳分院11例实施全腹腔镜全胃切除系膜离断食管空肠π形吻合胃癌患者资料，记录患者的手术时间、系膜离断食管空肠π形吻合时间、术中出血量、淋巴结清扫数目、术后并发症、术后住院时间、术后病理学检查等围手术期指标。

结果

11例胃癌患者均实施全腹腔镜全胃切除系膜离断食管空肠π形吻合，无中转开腹手术及围手术期死亡，手术时间(264.50±33.13)min，系膜离断食管空肠π形吻合时间(31.82±8.15)min，术中出血量(127.30±108.10)ml，淋巴结清扫数目(53.91±19.78)枚，术后住院时间(13.73±2.33)d。11例患者无术后吻合口瘘、出血、十二肠残端瘘及死亡等并发症，均顺利恢复出院。术后病理学检查显示：pTMN分期ⅠA期2例、ⅠB期2例、ⅡA期4例、ⅡB期1例、ⅢB期1例、ⅢC期1例。11例患者均获得术后随访，随访期间无胃癌术后复发、远处转移和死亡，手术满1年患者的内镜检查提示吻合口均通畅无狭窄。

结论

在胃癌患者中行腹腔镜全胃切除术，系膜离断食管空肠π形吻合安全、可行。

关键词: 胃肿瘤, 全胃切除术, π形吻合, 腹腔镜
Objective

To explore the safety and feasibility of the mesentery transected π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy.

Methods

A retrospective study was conducted by collecting the clinicopathological data of 11 gastric cancer patients in Liyang Branch Hospital of Jiangsu Province Hospital from Oct. 2018 to Dec. 2019. All patients underwent the mesentery transected π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy. Observation indicators included: operation time, time of the mesentery transected π-shaped esophagojejunostomy, volume of intraoperative blood loss, number of dissected lymph node, duration of postoperative hospital stay, postoperative pathological examination.

Results

All the 11 patients underwent successful totally laparoscopic total gastrectomy using the mesentery transected π-shaped esophagojejunostomy, without conversion to open surgery or perioperative death. The average operation time was (264.50±33.13) minutes, time of the mesentery transected π-shaped esophagojejunostomy was (31.82±8.15) minutes, intraoperative bleeding volume was (127.30±108.10) ml, number of dissected lymph node was (53.91±19.78), the average postoperative hospital stay was(13.73±2.33)days. 11 patients were not complicated with anastomotic fistula, hemorrhage, duodenal stump fistula or death, and all recovered smoothly. Postoperative pathological examination: pTNM staging showed that stage ⅠA, ⅠB, ⅡA, ⅡB, ⅢB and ⅢC were detected in 2, 2, 4, 1, 1 and 1 patients, respectively. All 11 patients were followed up. During follow-up, no tumor recurrence, metastasis or death occurred. Endoscopy after 1 year of operation showed that the anastomoses were unobstructed without anastomotic stenosis.

Conclusions

The mesentery transected π-shaped esophagojejunostomy is safe and feasible in totally laparoscopic total gastrectomy.

Key words: Gastric tumor, Total gastrectomy, π-shaped anastomosis, Laparoscopic
表1 11例胃癌患者一般资料
病例序号 性别 年龄(岁) 体质量指数(kg/m2) 术前cTNM分期
1 女 67 23.10 T1-2N0M0
2 男 75 19.70 T1-2N0M0
3 男 60 26.80 T3-4N＋M0
4 男 69 21.24 T3-4N＋M0
5 男 73 25.76 T1-2N0M0
6 男 61 18.73 T2-3N0M0
7 男 73 17.96 T1-2N0M0
8 男 71 23.44 T2-3N0M0
9 男 64 21.72 T3-4N＋M0
10 男 70 20.71 T2-3N0M0
11 男 67 25.25 T1-2N0M0
图1 全腹腔镜全胃切除系膜离断食管空肠π形吻合方式1
图2 全腹腔镜全胃切除系膜离断食管空肠π形吻合方式2
表2 11例全腹腔镜全胃切除系膜离断食管空肠π形吻合患者术中与术后情况
病例序号 术中 术后
手术时间(min) 吻合时间(min) 出血量(ml) 淋巴结清扫(枚) 首次下床时间(h) 首次进流食时间(d) 引流管拔除时间(d) 住院时间(d) 肿瘤直径(cm) pTNM分期
1 240 25 50 43 24 8 11 13 1.5 ⅡA
2 315 30 100 45 24 7 8 13 1.0 ⅠA
3 260 30 100 53 24 5 9 13 2.0 ⅢB
4 285 20 50 23 24 4 11 15 5.0 ⅡB
5 290 25 150 30 15 7 11 15 2.0 ⅠB
6 275 40 200 67 18 4 10 13 3.0 ⅡA
7 250 45 200 76 72 8 12 16 2.2 ⅠB
8 280 45 400 92 48 9 16 17 3.5 ⅡA
9 245 30 50 56 24 6 10 14 5.0 ⅢC
10 190 30 50 60 24 6 9 14 2.0 ⅡA
11 280 30 50 48 24 7 11 8 1.2 ⅠA
1
Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted billroth Ⅰ gastrectomy [J]. Surg Laparosc Endosc, 1994, 4(2): 146-148.
2
Kim JW, Kim WS, Cheong JH, et al. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial [J]. World J Surg, 2012, 36(12): 2879-2887.
3
杨力，徐泽宽，徐皓，等. 胃癌全腹腔镜下全胃切除食管空肠π形吻合临床体会[J]. 中华胃肠外科杂志，2016, 19(8): 948-950.
4
中华医学会外科学分会腹腔镜与内镜外科学组，中国研究型医院学会机器人与腹腔镜外科专业委员会. 腹腔镜胃癌手术操作指南(2016版) [J]. 中华消化外科杂志，2016, 15(9): 851-857.
5
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4) [J]. Gastric Cancer, 2017, 20(1): 1-19.
6
左婷婷，郑荣寿，曾红梅，等. 中国胃癌流行病学现状 [J]. 中国肿瘤临床，2017, 44(1): 52-58.
7
洪清琦，王伟，张健，等. 373例完全腹腔镜与腹腔镜辅助根治性全胃切除术疗效的多中心回顾性研究 [J]. 中华消化外科杂志，2017, 16(8): 822-827.
8
Son SY, Lee CM, Jung DH, et al. Laparoscopic completion total gastrectomy for remnant gastric cancer: a single-institution experience [J]. Gastric Cancer, 2015, 18(1): 177-182.
9
Kunisaki C, Makino H, Kimura J, et al. Application of reduced-port laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen [J]. Gastric Cancer, 2015, 18(4): 868-875.
10
Goh PM, Khan AZ, So JB, et al. Early experience with laparoscopic radical gastrectomy for advanced gastric cancer [J]. Surg Laparosc Endosc Percutan Tech, 2001, 11(2): 83-87.
11
李国新，陈新华，余江. 腹腔镜全胃切除食管空肠吻合方式安全性评价及应用 [J]. 中华消化外科杂志，2018, 17(6): 550-554.
12
黄昌明，黄泽宁．完全腹腔镜胃癌根治术后消化道重建的选择和操作要点[J/CD]．中华腔镜外科杂志(电子版)，2019，12(1): 34-36.
13
Inaba K, Satoh S, Ishida Y, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy[J]. Journal of the American College of Surgeons, 2010，211(6): 25-29.
14
Kwon IG, Son YG, Ryu SW. Novel intracorporeal esophagojejunostomy using linear staplers during laparoscopic total gastrectomy: pi-shaped esophagojejunostomy, 3-in-1 technique [J]. J Am Coll Surg, 2016, 223(3): 25-29.
15
蒿汉坤，洪军，王雅平，等. 自牵引后离断食管-空肠吻合术100例安全性评价 [J]. 中华胃肠外科杂志，2018, 21(2): 206-211.
16
杨力，徐泽宽. 腹腔镜全胃切除术后消化道重建的经验与思考[J/CD]. 中华腔镜外科杂志(电子版), 2019, 12(4): 207-212.
17
Papasavas PK, Caushaj PF, Mccormick JT, et al. Laparoscopic management of complications following laparoscopic roux-en-y gastric bypass for morbid obesity [J]. Surg Endosc, 2003, 17(4): 610-614.
[1] 吴丰信, 吴英光, 俞建雄, 王胜. 腹腔镜辅助保留幽门胃部分切除术治疗早期胃中部癌近期疗效分析[J]. 中华普通外科学文献(电子版), 2021, 15(05): 326-330.
[2] 周仕海, 陈宏, 张静, 雒洪志, 冯春在, 孙浩, 钟思全. 结直肠肿瘤经自然腔道取出标本手术67例分析[J]. 中华普通外科学文献(电子版), 2021, 15(05): 340-343.
[3] 黄厚锋, 刘子文, 范欣荣, 荣石, 纪志刚. 腹腔镜经腹腹膜前入路治疗成人腹股沟型隐睾合并腹股沟斜疝的临床研究[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(04): 337-341.
[4] 余磊, 魏寇准, 刘志刚, 陈光彬, 王志. 不同手术入路对腹腔镜下腹股沟疝修补术临床疗效[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(04): 361-365.
[5] 李林, 张琳琳, 王炜林. 喉罩与气管插管麻醉在腹股沟疝手术效果的临床比较[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(04): 369-371.
[6] 术者：张树彬 助手：邢中强 段佳悦 李昂 指导老师：刘建华 剪辑：徐晨. 健侧先行原位右半肝+全尾状叶切除的腹腔镜肝门部胆管癌根治术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[7] 褚薛慧. 腹腔镜肝右后叶切除术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[8] 卢攀 刘心怡 李坚 陈龙 张伟. 经脐单孔腹腔镜左半肝切除术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[9] 张硕, 杨军, 顾元龙. 腹腔镜胆囊切除术致胆道损伤的危险因素及处理[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 470-473.
[10] 吴志明, 黄洪军, 孟兴成, 葛佳皓, 沈丽青, 胡常恩, 虞洪. ERAS理念在腹腔镜胆总管切开取石一期缝合术中的应用[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 474-478.
[11] 丁天龙, 谷保红, 李雪梅, 胡继科, 张凡, 冯泽东, 马斌, 王琛, 陈昊. "脱衣法"腹腔镜胆囊切除术的应用[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 498-501.
[12] 王峰杰, 陈焕伟, 刘颖, 雷秋成, 宁燕文. 腹腔镜胰体尾切除手术入路及安全性[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 506-509.
[13] 李国林, 王秀, 陈桂婵, 邱逸红. 腹腔镜胰十二指肠切除术围手术期标准化管理[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 510-513.
[14] 李涛, 吐尔洪江·吐逊, 沙地克·阿帕尔, 白磊, 曹峻, 何翼彪, 王智鹏, 赵晋明. 全腹腔镜活体供肝右半肝切取术一例并文献复习[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 514-518.
[15] 蓝炘, 朴成林, 安峰铎, 谈明坤, 司振铎, 吴蔚, 赵娜, 冷建军. 3D腹腔镜与2D腹腔镜下肝癌切除术的短期疗效比较[J]. 中华临床医师杂志(电子版), 2021, 15(05): 327-330.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号