改良Overlap食管空肠去角吻合法在全腹腔镜根治性全胃切除术中应用研究

doi:10.19538/j.cjps.issn1005-2208.2025.09.14

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (09) : 1036-1040. DOI: 10.19538/j.cjps.issn1005-2208.2025.09.14

论著

改良Overlap食管空肠去角吻合法在全腹腔镜根治性全胃切除术中应用研究

蒋廷栋1，房立军2，武平3，陈羽佳1，何其通1，王大广1

作者信息 +

文章历史 +

摘要

目的探讨改良Overlap食管空肠去角吻合法在全腹腔镜下全胃根治术中的应用价值。方法研究组纳入2024年12月至2025年4月期间于吉林大学第一医院普通外科中心胃结直肠外科、辽源市人民医院普外科、辽源市中心医院普二外科行全腹腔镜下全胃根治切除术采用改良Overlap食管空肠去角吻合法的胃癌病人共21例；对照组34例，为同一时期采用传统Overlap食管空肠吻合法的胃癌病人。比较两组病人在围手术期及术后近期指标等方面有无差异。结果改良Overlap食管空肠去角吻合法要点：用切割闭合器横行离断食管，于食管断端右角开口，在胃管的引导下与空肠行Overlap吻合，共同开口使用切割闭合器分两次关闭，同时去除食管断端两个薄弱角。两组病人的一般资料比较，差异均无统计学意义（均P>0.05）。两组病人均顺利完成手术，无中转开放手术病例。在饮食随访中，研究组病人术后1个月均已恢复半流质饮食或普食，术后3个月均能进食普食。两组病人的术中出血量、术后住院时间以及吻合口漏的发生率相比较，差异均无统计学意义（均P>0.05）。同对照组相比较，研究组的食管空肠吻合时间［（27.8±3.7） min比（37.9±3.4） min，t=-9.519，P<0.001］和手术时间［（203.9±22.7）min比（215.1±14.5）min，t=-2.779，P=0.008］均缩短，差异具有统计学意义（均P<0.05）。结论全腹腔镜下改良Overlap食管空肠去角吻合操作简便，初步显示安全可行，有待进一步验证。

Abstract

To investigate the clinical value of the modified Overlap esophagojejunal angle-removing anastomosis in totally laparoscopic total gastrectomy. Methods The research group included 21 gastric cancer patients who underwent modified overlapping angle-removing anastomosis with total gastrectomy via laparoscopic surgery at the Department of Gastric and Colorectal Surgery, General Surgery Center, the First Hospital of Jilin University; Department of General Surgery, Liaoyuan People's Hospital; and Department of General Surgery Ⅱ, Liaoyuan Central Hospital between December 2024 and April 2025. The control group of 34 patients received conventional overlapping esophagal-jejunal anastomosis during the same period. The perioperative and short-term postoperative outcomes were compared between the two groups. Results Key steps of the modified Overlap esophagojejunal angle-removing anastomosis：The esophagus was transected horizontally with a linear cutter，an opening was made at the right angle of the esophageal stump，and an Overlap anastomosis was performed with the jejunum under the guidance of a gastric tube. The common anastomosis was closed in two steps using the linear cutter，while simultaneously removing the two weak angles of the esophageal stump. No statistically significant differences were observed in the general characteristics of the patients between the two groups (all P>0.05). All patients successfully underwent the surgery without conversion to open laparotomy. During dietary follow-up, all patients in the study group resumed semi-liquid or regular diets within 1 month postoperatively and were able to consume regular diets by 3 months postoperatively. No statistically significant differences were found between the two groups in terms of intraoperative hemorrhage volume, postoperative hospital stay, or incidence of anastomotic leakage (all P>0.05). Compared with the control group, the study group showed significantly shorter esophagojejunal anastomosis time ［(27.8±3.7) min vs. (37.9±3.4) min, t=-9.519, P<0.001］ and operative time ［(203.9±22.7) min vs. (215.1±14.5) min, t=-2.779, P=0.008］, with statistically significant differences (all P<0.05). Conclusion The modified Overlap esophagojejunal angle-removing anastomosis in totally laparoscopic total gastrectomy is operationally straightforward and preliminarily demonstrates safety and feasibility, warranting further validation.

导出引用

蒋廷栋1, 房立军2, 武平3, 陈羽佳1, 何其通1, 王大广1. 改良Overlap食管空肠去角吻合法在全腹腔镜根治性全胃切除术中应用研究[J]. 中国实用外科杂志. 2025, 45(09): 1036-1040 https://doi.org/10.19538/j.cjps.issn1005-2208.2025.09.14

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