中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

早期胃癌行腹腔镜手术消化道重建方式选择及评价

汪未知，吕嘉伦，徐泽宽   

  1. 南京医科大学第一附属医院胃肠外科中心，江苏南京210029
  • 出版日期:2019-05-01 发布日期:2019-05-06

  • Online:2019-05-01 Published:2019-05-06

摘要：

近年来，随着腹腔镜技术的发展和外科医生技术水平的不断提高，针对早期胃癌的腹腔镜胃癌根治术在国内外各大中心获得广泛开展，但是腹腔镜下消化道重建仍然是全腹腔镜手术成功实施的关键。目前，全腹腔镜下早期胃癌根治术的肿瘤学安全性已经得到初步证实。全腹腔镜下远端胃切除术后消化道重建包括BillrothⅠ式吻合，BillrothⅡ式吻合和Roux-en-Y吻合；近端胃切除术后消化道重建包括传统的食管残胃吻合及其演变而来的抗反流吻合；而全胃切除术后消化道重建包括使用管形吻合器或线形吻合器的食管空肠吻合。这些重建方式各具特点，目前未达成统一共识。在临床实践中，必须以病人为中心，因地制宜，在确保肿瘤根治性的前提下，选择合适的消化道重建方式。

关键词: 早期胃癌, 腹腔镜, 消化道重建, 吻合

Abstract:

Selection and evaluation of laparoscopic digestive tract reconstruction after gastrectomy for early gastric cancer　　　WANG Wei-zhi, LYU Jia-lun, XU Ze-kuan,et al. Gastrointestinal Surgery Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Corresponding author: XU Ze-kuan , E- mail: xuzekuan@njmu.edu.cn
Abstract　In recent years, with the development of laparoscopic technology and the improvement of surgeons' skill, laparoscopic radical gastrectomy for early gastric cancer has been widely achieved in large centers worldwide. But digestive reconstruction under laparoscopy is still the most important for totally laparoscopic surgery. At present, the oncological safety of totally laparoscopic gastrectomy for early gastric cancer has been preliminarily confirmed. Digestive tract reconstruction after totally laparoscopic distal gastrectomy includes Billroth-Ⅰanastomosis, Billroth-Ⅱ anastomosis and Roux-en-Y anastomosis; after proximal gastrectomy, it includes traditional esophagogastric anastomosis and evolutionary anti-reflux surgery; for total gastrectomy, itincludes esophageal jejunal anastomosis by using circular stapler and linear stapler. These reconstruction methods have their own characteristics, and no consensus has been reached at present. However, in clinical practice, it is necessary to focus on the patient, adjust measures to local conditions, and select the appropriate digestive tract reconstruction method on the premise of ensuring the radical cure of tumors.

Key words: early gastric cancer, laparoscopy, digestive tract reconstruction, anastomosis