Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer
Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer
复制标题
DOI：
10.1007/s00464-008-9987-8
复制
发表时间：
2009-09-01
影响因子：
3.1
通讯作者：
Sakai, Yoshiharu
中科院分区：
文献类型：
--
作者：
Okabe, Hiroshi;Obama, Kazutaka;Sakai, Yoshiharu
为了使腹腔镜全胃切除术（LTG）治疗胃上部癌患者更容易被接受，一种简单、安全的重建技术是必要的。2006年9月至2008年1月，16名胃癌患者（11名男性和5名女性）在作者所在机构接受了LTG。所有患者均尝试使用以下方法进行腹腔镜食管空肠吻合术。在逆时针旋转约45 A度的同时横切食管，以使后续吻合更容易。在建立Y形吻合后，应用内镜直线型吻合器在食管左背侧和空肠分支之间建立侧侧吻合。首先用疝吻合器粗略闭合入孔。随后使用腔镜直线型吻合器，取出所有疝吻合器，完成闭合，15例患者成功完成腹腔镜食管空肠吻合术。1例患者的鼻胃管吻合失败，因为鼻胃管卡在内镜吻合器的钳口之间，导致转为开放手术。术后无吻合口并发症发生，采用新技术，可方便、安全地进行结肠内直线型吻合器食管空肠吻合。这项技术可能成为LTG后重建的标准方法之一，促进LTG作为胃上部癌患者的手术选择的接受。
To facilitate acceptance of laparoscopic total gastrectomy (LTG) for patients with upper gastric cancer, a simple, secure technique of reconstruction is necessary. The authors developed a new technique for intracorporeal esophagojejunal anastomosis that does not require hand sewing.From September 2006 to January 2008, 16 patients (11 men and 5 women) with gastric cancer underwent LTG at the authors' institution. Laparoscopic esophagojejunal anastomosis using the following method was attempted for all patients. The esophagus was transected while being rotated by about 45A degrees counterclockwise to make the subsequent anastomosis easier. After the Y-anastomosis was created, an endoscopic linear stapler was applied to create a side-to-side anastomosis between the left dorsal side of the esophagus and the jejunal limb. The entry hole was first closed roughly with hernia staplers. Subsequently, an endoscopic linear stapler was applied so that all hernia staplers could be removed and the closure completed.Laparoscopic esophagojejunal anastomosis was successfully performed for 15 patients. Intracorporeal anastomosis failed for one patient because a nasogastric tube was caught between the jaws of an endostapler, which resulted in a conversion to open procedure. No postoperative anastomotic complications occurred.Using the new technique, intracorporeal linear-stapled esophagojejunal anastomosis can be performed easily and securely. This technique could become one of the standard methods for reconstruction after LTG, facilitating the acceptance of LTG as a surgical option for patients with upper gastric cancer.