关键词: 食管空肠手工吻合, 腹腔镜全胃切除术, 胃癌, 食管胃结合部癌

Abstract: To investigate the clinical value of laparoscopic hand-sewn esophagojejunal anastomosis after totally laparoscopic total gastrectomy(TLTG). Methods    A retrospective descriptive study was conducted. Clinical and pathological data of 10 patients with gastric cancer or esophago gastric junction cancer who underwent TLTG and hand-sewn esophagojejunal anastomosis at Peking Union Medical College Hospital from September 2021 to January 2024 were collected. The intraoperative condition, postoperative recovery and postoperative pathological examination results of the enrolled patients were counted. Results    (1) There were 8 males and 2 females, with an average age of (62.6±6.4) years. Intraoperative data: The average operation time was (234.2±55.1) minutes, with a median intraoperative blood loss of 100 (range 50-800) mL, and an average anastomosis time of (40.4±7.5) minutes. One patient received 400 mL of red blood cells intraoperatively, while the remaining 9 patients did not require blood transfusion. No patients required conversion to open surgery. (2) Postoperative data: Three patients were monitored in the ICU for 1 day; the postoperative gastric tube was retained for (2.9±0.9) days, with the first water intake occurring at (2.9±1.3) days postoperatively and the first liquid diet intake at (5.6±0.8) days postoperatively. On average, all abdominal drainage tubes were removed at (7.8±1.5) days postoperatively. The average length of postoperative hospital stay was (11.6±3.4) days. No anastomotic fistula, anastomotic bleeding, or anastomotic stenosis were observed. (3) Postoperative pathology: One case of well-differentiated adenocarcinoma, one case of moderately to well-differentiated adenocarcinoma, four cases of moderately differentiated adenocarcinoma, one case of poorly differentiated adenocarcinoma, two cases of signet ring cell carcinoma, and one case of moderately to poorly differentiated squamous cell carcinoma. In terms of TNM staging, there were 3 cases of stage ⅠA, 3 cases of stage ⅠB, 2 cases of stage ⅡA, and 2 cases of stage ⅢB. The average number of removed lymph nodes was 29.4±11.4. Seven patients had no lymph node metastasis. Among the 3 patients with lymph node metastasis, the number of metastases was 6 (range 2-10). The pathological examination of the proximal end of the esophagus was negative for all patients, and all patients achieved R0 resection. Conclusion    For surgeons proficient in laparoscopic suturing techniques, TLTG with hand-sewn esophagojejunal anastomosis is safe and feasible and has certain clinical utility.

Key words: hand-sewn esophagojejunal anastomosis, totally laparoscopic total gastrectomy, gastric cancer, esophagogastric junction cancer