Intracorporeal Billroth-I anastomosis using a circular stapler by the abdominal wall lifting method in laparoscopy-assisted distal gastrectomy.
Intracorporeal Billroth-I anastomosis using a circular stapler by the abdominal wall lifting method in laparoscopy-assisted distal gastrectomy.
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DOI：
10.1097/sle.0b013e3181b6c867
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发表时间：
2009-10-01
期刊：
影响因子：
--
通讯作者：
Otsuji, Eigo
中科院分区：
文献类型：
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作者：
Ichikawa, Daisuke;Kubota, Takeshi;Otsuji, Eigo
背景技术背景：腹腔镜辅助远端胃切除术（LADG）是近年来公认的治疗早期胃癌的首选手术方式。Billroth-I法因其生理优势和技术简便而被广泛应用。方法：自2007年9月以来，我们对35例早期胃癌患者进行了标准化LADG。在这35名患者中，27名患者采用Billroth-I吻合术进行重建。11例患者在直视下进行胃十二指肠吻合术（体外），其余16例患者在腹腔镜下用直角牵开器提升腹壁（腹腔镜内）进行吻合术。结果：体外和腹腔镜内患者的吻合术平均持续时间分别为17和20 min。用直角牵开器的腹部提升方法提供了良好的视野，而无需重新建立气腹。腹腔镜精细视野可防止周围脂肪组织和器官介入吻合平面，从而指导准确、安全的吻合。无论是血管相关的，也没有胰腺相关的并发症，观察在这个series.Conclusions：这种吻合技术应该是有用的，作为一种简单，安全的重建方法在LADG，尤其是经验不足的腹腔镜胃外科医生。
BACKGROUND: Laparoscopy-assisted distal gastrectomy (LADG) has recently been accepted as a preferred surgical procedure for patient with early gastric cancer. The Billroth-I method has been performed widely because of physiologic advantages and technical simplicity.METHODS: Since September 2007, we performed standardized LADG for 35 patients with early gastric cancer. Of these 35 patients, 27 patients were reconstructed by Billroth-I anastomosis. Gastroduodenostomy was performed under direct vision for 11 patients (extracorporeal) and remaining 16 patients were anastomosed under laparoscopic vision facilitated by abdominal wall lifting with a right angle retractor (intracorporeal).RESULTS: The mean duration of the anastomosis procedure was 17 and 20 minutes in extracorporeal and intracorporeal patients, respectively. The abdominal lifting method with a right angle retractor provided a good visual field without reestablishing pneumoperitoneum. The laparoscopic fine view could prevent surrounding fatty tissues and organs from intervening between the anastomosis planes and consequently guided an accurate and safe anastomosis. Neither anastomotic-related nor pancreatic-related complication was observed in this series.CONCLUSIONS: This anastomotic technique should be useful as an easy and safe reconstruction method in LADG and is especially recommendable for less-experienced laparoscopic gastric surgeons.