腹腔镜胃切除后食管残胃和食管空肠吻合新技术

被引：12

作者：

柯重伟

陈丹磊

丁丹

机构：

[1] 第二军医大学附属长海医院微创外科

来源：

中华消化外科杂志 | 2011年 / 03期

关键词：

胃肿瘤; 腹腔镜检查; 胃切除术; 食管残胃吻合术; 食管空肠吻合术;

D O I：

暂无

中图分类号：

R735.2 [胃肿瘤];

学科分类号：

摘要：

目的探讨经口腔放置倾斜的圆形抵钉座(OrVilTM装置)进行腹腔镜胃切除后食管残胃和食管空肠吻合的疗效。方法回顾性分析2009年7月至2011年2月第二军医大学附属长海医院收治的接受OrVilTM装置在腹腔镜下进行消化道重建的34例胃肿瘤患者的临床资料。手术采用4孔法,在完成淋巴结清扫以及食管游离后,先横断食管;然后在食管断端开口,将含OrVilTM装置的胃管从该开口穿出,并将抵钉座带入腹腔;最后在腹腔镜监视下,在体内完成食管残胃或食管空肠吻合。结果 34例患者手术顺利,无中转开腹。其中32例经口腔放置OrVilTM装置顺利;2例经口腔放置OrVilTM装置困难,经放掉患者气管插管气囊内的气体并将其头部后仰后顺利放置。34例患者平均手术时间为175 min（90～240 min）;术中平均出血量为196 ml（50～800 ml）;术后平均住院时间为7.6 d（5～14 d）;术后胃肠功能平均恢复时间为3 d（2～6 d）,并开始进食流质饮食和下床活动。术后未出现吻合口漏。33例患者获得随访,平均随访时间为（10±6）个月（2～20个月）,无肿瘤复发和转移发生。结论 OrVilTM装置改变了以往抵钉座的置入方向,这一技术可以避免开胸手术,降低腹腔镜下消化道重建的操作难度,缩短手术时间。

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