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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；

论著

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 Zhu1, Guozhong Yao1, Li Yang2,†(), Hao Fan3, Hongzhi Zhang1, Jianjun Wu1, Jiang Yan1   

  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:
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引用本文：

朱初明, 姚国忠, 杨力, 范浩, 张洪志, 吴建军, 晏江. 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[J/OL]. 中华腔镜外科杂志(电子版), 2020, 13(04): 207-211.

Chuming Zhu, Guozhong Yao, Li Yang, Hao Fan, Hongzhi Zhang, Jianjun Wu, Jiang Yan. Application of the mesentery transected π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(04): 207-211.

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
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