Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: Inverted T-shaped anastomosis using linear staplers
Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: Inverted T-shaped anastomosis using linear staplers
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DOI：
10.1016/j.surg.2012.10.012
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发表时间：
2013-05-01
期刊：
影响因子：
3.8
通讯作者：
Tanaka, Masao
中科院分区：
文献类型：
--
作者：
Nagai, Eishi;Ohuchida, Kenoki;Tanaka, Masao
背景。虽然腹腔镜远端胃切除术在临床上已被广泛接受，但由于食管空肠吻合术的困难，腹腔镜全胃切除术（LTG）尚不为人所熟悉。本研究的目的是评估我们在ltg术后使用线性吻合器进行胃胃吻合术的围手术期和短期效果。在我科2002年8月至2010年12月连续98例胃癌行LTG的患者中，94例患者行线性吻合器食管空肠吻合术。2007年10月后，我们改良了食管空肠吻合术；即，最近57例患者行食管腹背侧横断，从Roux肢前壁至后壁插入线性吻合器，行倒t形吻合。我们评估了这57例患者（近期组）的结果，并将其与早期37例患者（早期组）的结果进行了比较。近期组平均手术时间为368 ~ 94.6 min，平均估计失血量为57 ~ 33 g；两者都与早期组相当。手术中未发生开放性转换和术中并发症。早期组有2例出现吻合口瘘，近期组无吻合口瘘。无死亡病例。我们在此报告我们在LTG术后使用线性吻合器进行胃空肠肠内吻合术的方法。我们使用线性吻合器进行食管空肠吻合术是安全可行的，而且发病率是可以接受的。(手术2013;153:732-8)。
Background. Although laparoscopic distal gastrectomy has been widely accepted in clinical practice, laparoscopic total gastrectomy (LTG) is not yet familiar because of the difficulty in esophagojejunostomy. The purpose of this study was to evaluate perioperative and short-term outcomes of our procedure of intracorporeal gastrojtjunostomy using linear staplers after LTG.Methods. Of 98 consecutive patients who underwent LTG for gastric cancer in our department between August 2002 and December 2010, 94 patients underwent esophagojejunostomy with a linear stapling device. After October 2007, we modified the esophagojejunostomy; ie, the most recent 57 patients underwent transection of the esophagus in the ventrodorsal direction and insertion of a linear stapler from the anterior wall of the Roux limb to the posterior wall so as to make an inverted T-shaped anastomosis. We evaluated the results in these 57 patients (recent group) and compared them with the results in the earlier 37 patients (early group).Results. The mean operative time in the recent group was 368 to 94.6 min, and the mean estimated blood loss was 57 to 33 g; both were comparable with those in the early group. Neither open conversion nor intraoperative complications were encountered. Two patients experienced anastomotic leakage in the earlier group, but anastomotic leakage did not occur in the recent group. No mortality was encountered.Conclusion. We herein report our procedure of intracorporeal gastrojejunostomy using linear staplers after LTG. Our procedure of esophagojejunostomy using linear staplers is safe and feasible and has acceptable morbidity. (Surgery 2013;153:732-8.)