Impact of stepwise introduction of esophagojejunostomy during laparoscopic total gastrectomy: a single-center experience in Japan.
Impact of stepwise introduction of esophagojejunostomy during laparoscopic total gastrectomy: a single-center experience in Japan.
复制标题
腹腔镜总胃切除术期间食管何诺施术的逐步引入的影响：日本的单中心体验。
DOI：
10.20524/aog.2017.0157
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发表时间：
2017
影响因子：
2.2
通讯作者：
Yoshimura T
中科院分区：
文献类型：
--
作者：
Yasukawa D;Hori T;Kadokawa Y;Kato S;Machimoto T;Hata T;Aisu Y;Sasaki M;Kimura Y;Takamatsu Y;Ito T;Yoshimura T
随着腹腔镜和手术器械的发展，在日本进行腹腔镜胃切除术的数量正在增加。然而，腹腔镜全胃切除术发展相对缓慢，因为技术上的困难，特别是在食管空肠吻合。我们回顾性分析了2007年4月至2016年3月期间接受腹腔镜全胃切除术的83例胃上部早期胃癌患者。我们将患者分为三个阶段，主要是根据所进行的食管空肠吻合术：第一阶段，根据医生的选择进行各种常规手术（n=14）;第二阶段，经口方法（n=51）;第三阶段，完全腔内技术（n=18）。我们评估了在腹腔镜全胃切除术中逐步引入不熟悉的新方法的临床影响。在第一阶段和第二阶段之间，失血量、收获的淋巴结数量、转为开放手术的频率和术后住院时间存在显著差异。第三阶段的淋巴结收获数量明显高于第二阶段，对其他术中或术后因素没有影响。使用统一的手术方法进行食管空肠吻合似乎是成功和有利的腹腔镜全胃切除术的关键。在腹腔镜全胃切除术中逐步引入成熟的食管空肠吻合技术将使患者受益，例如，本研究中清扫的淋巴结数量较高。然而，需要一个漫长的学习曲线。
The number of laparoscopic gastrectomies performed in Japan is increasing with the development of laparoscopic and surgical instruments. However, laparoscopic total gastrectomy is developing relatively slowly because of technical difficulties, particularly in esophagojejunostomy. We retrospectively reviewed 83 patients with early gastric cancer in the upper portion of the stomach who underwent laparoscopic total gastrectomy between April 2007 and March 2016. We classified the patients into three periods, mainly on the basis of the esophagojejunostomy procedures performed: first period, various conventional procedures based on the physicians’ choice (n=14); second period, transoral method (n=51); and third period, fully intracorporeal technique (n=18). We evaluated the clinical impact of a stepwise introduction of unfamiliar new methods during laparoscopic total gastrectomy. Between the first and second periods, there were significant differences in the blood loss volume, number of harvested lymph nodes, frequency of conversion to open surgery, and postoperative hospital stay. The number of harvested lymph nodes was significantly higher in the third than in the second period, with no detriment to other intraoperative or postoperative factors. The use of a unified surgical method for esophagojejunostomy seems to be the key to a successful and advantageous laparoscopic total gastrectomy. Stepwise introduction of a well-established technique of esophagojejunostomy during laparoscopic total gastrectomy will benefit patients, as shown, for example, by the higher number of dissected lymph nodes in the present study. However, a protracted learning curve is required.