Intracorporeal Billroth 1 reconstruction by triangulating stapling technique after laparoscopic distal gastrectomy for gastric cancer
Intracorporeal Billroth 1 reconstruction by triangulating stapling technique after laparoscopic distal gastrectomy for gastric cancer
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DOI：
10.1097/sle.0b013e3181568e63
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发表时间：
2008-02-01
影响因子：
1
通讯作者：
Sugi, Harushi
中科院分区：
文献类型：
--
作者：
Tanimura, Shinya;Higashino, Masayuki;Sugi, Harushi
随着腹腔镜下胃癌手术的增多，体外消化道重建受到了人们的关注，因为无论患者的身材如何，该手术都能提供良好的视野。我们于1998年3月至2006年6月对586例胃癌患者行腹腔镜胃切除术并区域淋巴结清扫，其中465例为远端胃切除术，42例为近端胃切除术，79例为全胃切除术。其中分别有303例、36例和69例行体内吻合。303例胃远端切除术及胃内吻合术中226例行胃内Billroth 1重建。226例中有196例采用“三角缝合技术”（TST），即使用腹腔镜下的线性吻合器；其余30例采用常规开放式胃切除术（CEEA）的圆形吻合器。在最初的115例胃远端切除术中，我们使用手辅助腹腔镜手术（HALS），然后我们转向不使用HALS的全腹腔镜胃远端切除术（TLDG）。本文主要介绍了TST在体内重建Billroth 1的技术和结果。与HALS和体外吻合，即腹腔镜辅助胃远端切除术相比，TST可以减少术后伤口。吻合并发症导致2例HALS-TST患者和1例TLDG-TST患者出现吻合口漏，每1例采用CEEA重建均出现吻合口狭窄和出血。TST体内Billroth 1重建是一种安全的手术，无论患者的身材如何，都能提供良好的视野，是腹腔镜胃远端切除术后重建的可行技术。
As the laparoscopic operations for gastric cancer have increased, the intracorporeal reconstruction of the digestive tract has received attention because the procedure offers a good visual field regardless of the patient's figure. We performed laparoscopic gastrectomies with regional lymph node dissection on 586 gastric cancer patients between March 1998 and June 2006: 465 distal gastrectomies, 42 proximal gastrectomies, and 79 total gastrectomies. Intracorporeal anastomosis was carried out in 303, 36, and 69 of the above cases, respectively. The intracorporeal Billroth 1 reconstruction was performed in 226 out of the 303 cases who underwent distal gastrectomy and intracorporeal anastomosis. The "triangulating stapling technique" (TST) that uses laparoscopic linear stapling devices was adopted for 196 of these 226 cases; in the remaining 30, circular stapling devices for conventional open gastrectomy (CEEA) were used. In the initial 115 cases of distal gastrectomy, hand-assisted laparoscopic surgery (HALS) was used, and then we shifted to totally laparoscopic distal gastrectomy (TLDG) without HALS. In this paper, we concentrated on the techniques and results of intracorporeal Billroth 1 reconstruction by TST. Reducing postoperative wounds was possible TLDG by TST, compared with HALS and the extracorporeal anastomosis, that is, laparoscopy-assisted distal gastrectomy. Complications from anastomosis resulted in leakage in 2 HALS-TST patients and in 1 TLDG-TST patient, and anastomotic stenosis and bleeding were observed in each 1 case of reconstruction that used CEEA. Intracorporeal Billroth 1 reconstruction by TST is a safe procedure that provides a good visual field regardless of the patient's figure and a feasible technique for reconstruction after laparoscopic distal gastrectomies.