反穿刺技术在腹腔镜近端胃切除食管-残胃吻合中的应用价值

发布时间：2018-03-01 14:06

本文关键词： 腹腔镜手术反穿刺技术食管-残胃吻合消化道重建　出处：《中国微创外科杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的探讨反穿刺技术在腹腔镜近端胃切除食管-残胃吻合手术中的安全性和应用价值。方法我科2014年5月~2015年5月在腹腔镜近端胃切除手术中采用反穿刺技术,即切开食管前壁置入反穿刺器,由切口上方3 cm穿出导线后闭合食管完成吻合器钉座置入,再通过辅助小切口在镜下完成食管-残胃吻合11例。结果 11例手术均获得成功,无中转开腹手术。手术时间(212.1±47.9)min,完成吻合时间(63.5±9.7)min,钉座置入时间(20.5±6.8)min,术中出血量(136±28)ml,辅助切口长度(4.6±0.5)cm,术后排气时间(2.3±0.6)d,住院时间(10.7±2.2)d,肿瘤距食管断端距离(4.3±1.1)cm。围手术期无死亡,无吻合口漏、吻合口出血等并发症发生。术后病理食管断端均未见肿瘤浸润。11例随访(17.8±3.2)月,无复发,术后3个月发现吻合口狭窄1例,经内镜下扩张后缓解。结论反穿刺技术在腹腔镜近端胃切除手术中完成食管-残胃吻合能简化手术操作,简单易行,安全可靠,是一种值得推广的吻合方式。
[Abstract]:Objective to investigate the safety and application value of reverse puncture technique in laparoscopic proximal gastrectomy with esophagogastric remnant anastomosis. Methods from May 2014 to May 2015, we used reverse puncture technique in laparoscopic proximal gastrectomy. That is to say, the anterior wall of the esophagus was cut into the anterior wall of the esophagus and the reverse puncture device was inserted. The anastomotic stapler was inserted into the esophagus by closing the esophagus through a traverse 3 cm above the incision, and the anastomosis of the esophagus and the remnant stomach was completed under the microscope through an auxiliary small incision in 11 cases. Results all the 11 cases were successfully operated. The operative time was 212.1 卤47.9 min, the complete anastomosis time was 63.5 卤9.7 min, the insertion time of nail pedestal was 20.5 卤6.8 min, the intraoperative bleeding was 136 卤28ml, the length of auxiliary incision was 4.6 卤0.5 cm, the postoperative exhaust time was 2.3 卤0.6 days, the hospitalization time was 10.7 卤2.2 d, and the distance from the esophageal end to the tumor was 4.3 卤1.1 cm. There was no death and no anastomotic leakage during the perioperative period. Anastomotic bleeding and other complications occurred. No tumor infiltration was found in all patients. No recurrence was found in 11 cases. Anastomotic stricture was found in 1 case 3 months after operation. Conclusion Endoscopic esophagogastrostomy is a simple, safe and reliable way to complete esophagogastric anastomosis in laparoscopic proximal gastrectomy.
【作者单位】：攀钢集团总医院普通外科;
【分类号】：R735.2

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