中国实用外科杂志

中国实用外科杂志 ›› 2023, Vol. 43 ›› Issue (09): 1027-1032.DOI: 10.19538/j.cjps.issn1005-2208.2023.09.16

• 论著 • 上一篇    下一篇

改良单孔平台在单孔plus腹腔镜全胃切除食管空肠管状吻合术中应用研究

刘文居，刘声源，王志纬，滕文浩，姜键平，陈梅梅，臧卫东   

  1. 福建医科大学肿瘤临床医学院  福建省肿瘤医院胃肠肿瘤外科，福建福州 350014
  • 出版日期:2023-09-01 发布日期:2023-09-21

  • Online:2023-09-01 Published:2023-09-21

摘要： 目的    探讨改良单孔平台在单孔plus腹腔镜全胃切除食管空肠Roux-en-Y管状吻合术中的应用价值。方法    回顾性分析2022年1月至2023年4月期间福建省肿瘤医院收治的采用改良单孔平台行单孔plus腹腔镜根治性全胃切除食管空肠Roun-en-Y管状吻合术的39例胃癌病人的临床病理资料，并详细记录其围手术期各项指标，门诊复查及电话随访至术后30 d，获得病人术后近期生存情况。结果    39例病人均顺利完成单孔plus腹腔镜手术，其中单孔加一孔腹腔镜根治性全胃切除术34例，单孔加二孔腹腔镜根治性全胃切除术5例，改良单孔平台装置后重建气腹，利用圆形吻合器在腹腔镜直视下完成食管空肠Roun-en-Y端侧吻合，无中转为开腹或传统腹腔镜辅助手术，无围手术期死亡，术后病理学检查显示切缘均为阴性。中位手术时间为200（180，240）min，术中出血量为30（20，50）mL，无术中并发症发生。术后前3 d疼痛评分分别为（1.8±0.4）、（1.1±0.6）、（0.6±0.5），术后首次排气时间（68.9±2.9）h，术后住院天数（9.9±2.0）d，切口长度为（4.2±0.7）cm，肿瘤近切缘距离为2.5（1.5，3.5）cm，淋巴结清扫数目为（37.3±16.4）枚。术后30 d并发症发生率为7.7%（3/39），包括肺部感染1例，腹腔感染2例。术后美容评价为“非常满意”占97.4%。所有病人均随访至术后30 d以上，生存状态良好。结论    改良单孔平台装置应用于单孔plus腹腔镜全胃切除食管空肠Roux-en-Y管状吻合术是安全可行的，且近期疗效满意，可以选择合适病例进行开展。

关键词: 胃肿瘤, 全胃切除术, 腹腔镜, 食管空肠吻合术, 单孔腹腔镜手术

Abstract: Application of modified single-port platform in single-incision plus laparoscopic total gastrectomy of esophagojejunal circular anastomosis        LIU Wen-ju, LIU Sheng-yuan, WANG Zhi-wei, et al. Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China
Corresponding author：ZANG Wei-dong，E-mail:fjzangwd@163.com
Abstract    Objective    To investigate the application of the modified single-port platform in single-incision plus laparoscopic total gastrectomy of esophagojejunum Roux-en-Y circular anastomosis. Methods    Clinical data of 39 patients with gastric cancer who underwent single-incision plus laparoscopic total gastrectomy of esophagojejunum Roux-en-Y circular anastomosis with modified single-port platform were retrospectively analyzed from January 2022 to April 2023 in Fujian Cancer Hospital.The perioperative indexes were recorded in detail. All patients were followed up 30 days after operation by outpatient review or telephone, and the postoperative survival of patients was obtained. Results  All 39 patients successfully completed single-incision plus laparoscopic surgery. There were 34 cases of single-incision plus one-port laparoscopic radical total gastrectomy and 5 cases of single-incision plus two-port laparoscopic radical total gastrectomy. The numbering was reconstructed after modification of the single-port platform device, and the Roux-en-Y end-to-side anastomosis of the esophagojejunum was completed using a circular stapler under direct view. No patient was converted to open or conventional laparoscopic assistant surgery. There was no perioperative death, and the postoperative pathological margins were all negative. The median operation time was 200（180, 240）min. The median intraoperative blood loss was 30（20, 50）mL, and no intraoperative complications occurred. The mean VAS scores for the 3 days after surgery were（1.8±0.4）, （1.1±0.6）, （0.6±0.5）, respectively. The postoperative exhaust time was（68.9±2.9）h; the postoperative average hospital stay was（9.9±2.0）days.The incision length was（4.2±0.7）cm. The median proximal distance of tumor was 2.5（1.5，3.5）cm, and the number of lymph nodes harvested was 37.3±16.4. The incidence of complications in 30 days after operation was 7.7%（3/39）, including 1 case of lung infection, and 2 cases of abdominal infection. Postoperative cosmetic evaluation with very satisfied reviews accounted for 97.4%. All patients were followed up for more than 30 days after surgery and survived well. Conclusion    The application of the modified single-port platform device to single-incision plus laparoscopic total gastrectomy esophagojejunal Roux-en-Y circular anastomosis is safe and feasible, and the short-term efficacy is satisfactory, It can choose suitable cases to carry out.

Key words: gastric neoplasms, total gastrectomy, laparoscope, esophagojejunostomy, single incision laparoscopic surgery