中国实用外科杂志

中国实用外科杂志

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手工缝合法食管空肠吻合在全腹腔镜全胃切除术中应用

徐晓武1，张人超1，牟一平1，黄超杰1，周育成1，周家瑜2，马    君1，胡俊峰1   

  1. 1 浙江省人民医院胃肠胰外科  浙江省胃肠病学重点实验室，浙江杭州310014；2 浙江大学医学院，浙江杭州 310029
  • 出版日期:2016-09-01 发布日期:2016-08-24

  • Online:2016-09-01 Published:2016-08-24

摘要：

全腹腔镜全胃切除术（TLTG）后手工缝合法食管空肠吻合口重建的所有操作均在直视下完成，具有原位吻合安全确切、对食管残端游离长度要求较低、经济性高等特点。2012年至今，浙江省人民医院已完成TLTG后手工缝合法食管空肠吻合63例，无中转开腹，手术时间（273.4±52.3）min，食管空肠吻合时间（61.4±19.2）min。术后下床活动时间为（2.1±1.0）d，肛门排气时间为（3.1±0.9）d，进食流质时间为（4.2±1.0）d，术后住院时间（8.1±2.4）d，术后无吻合口漏、狭窄。良好的显露、术者腹腔镜下缝合经验和配合默契的团队，是顺利进行手工缝合法腹腔镜食管空肠吻合的关键。

关键词: 胃肿瘤, 全胃切除术, 手工缝合, 腹腔镜

Abstract:

Application of intracorporeal hand-sewn esophagojejunostomy after totally laparoscopic total gastrectomy        XU Xiao-wu*，ZHANG Ren-chao，MOU Yi-ping，et al. *Department of Gastrointestinal and Pancreatic Surgery，Zhejiang Provincial People’s Hospital；Core Lab on Gastroenterology of Zhejiang Province，Hangzhou 310014，China
Corresponding author：MOU Yi-ping，E-mail：yipingmou@126.com
Abstract    Intracorporeal hand-sewn esophagojejunostomy after totally laparoscopic total gastrectomy (TLTG) is feasible and safe. The suturing process can be totally and clearly manipulated under laparoscopy to ensure the anastomosis reliability besides being cost-effective. The approach requires no excessive mobilization of the esophagus and Roux limb and less tissue injury of anastomosis site. From 2012，A total of 63 consecutive patients underwent TLTG with intracorporeal hand-sewn end-to-side esophagojejunostomy in Zhejiang Provincial People’s Hospital. The mean operation time was （273.4±52.3）min. The mean reconstruction time was （61.4±19.2） min，without any conversion to open surgery or laparoscopy assisted surgery. The  average time to out-of-bed activity was  （2.1±1.0） d. The average time until the first flatus was （3.1±0.9）d. The average time to start liquid diet was （4.2±1.0） d. The average postoperative hospital stay was （8.1±2.4） d. There was no sign of anastomotic leaks and strictures in any patient. The key to perform intracorporeal hand-sewn esophagojejunostomy after laparoscopic total gastrectomy is well exposure, extensive experience and closely cooperated team.

Key words: stomach neoplasm, total gastrectomy, hand-sewn;laparoscopy