中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2011年
3期
191-195
,共5页
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
胃腫瘤%腹腔鏡檢查%胃切除術%食管殘胃吻閤術%食管空腸吻閤術
위종류%복강경검사%위절제술%식관잔위문합술%식관공장문합술
Gastric neoplasms%Laparoseopy%Gastrectomy%Esophagogastrostomy%Esophagojejunostomy
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,并将抵钉座带人腹腔;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,缩短手术时问.
目的 探討經口腔放置傾斜的圓形牴釘座(OrVilTM裝置)進行腹腔鏡胃切除後食管殘胃和食管空腸吻閤的療效.方法 迴顧性分析2009年7月至2011年2月第二軍醫大學附屬長海醫院收治的接受OrVilTM裝置在腹腔鏡下進行消化道重建的34例胃腫瘤患者的臨床資料.手術採用4孔法,在完成淋巴結清掃以及食管遊離後,先橫斷食管;然後在食管斷耑開口,將含OrVilTM裝置的胃管從該開口穿齣,併將牴釘座帶人腹腔;最後在腹腔鏡鑑視下,在體內完成食管殘胃或食管空腸吻閤.結果 34例患者手術順利,無中轉開腹.其中32例經口腔放置OrVilTM裝置順利;2例經口腔放置OrVilTM裝置睏難,經放掉患者氣管插管氣囊內的氣體併將其頭部後仰後順利放置.34例患者平均手術時間為175 min(90～240 min);術中平均齣血量為196 ml(50～800 ml);術後平均住院時間為7.6 d(5～14 d);術後胃腸功能平均恢複時間為3 d(2～6 d),併開始進食流質飲食和下床活動.術後未齣現吻閤口漏.33例患者穫得隨訪,平均隨訪時間為(10±6)箇月(2～20箇月),無腫瘤複髮和轉移髮生.結論 OrVilTM裝置改變瞭以往牴釘座的置入方嚮,這一技術可以避免開胸手術,降低腹腔鏡下消化道重建的操作難度,縮短手術時問.
목적 탐토경구강방치경사적원형저정좌(OrVilTM장치)진행복강경위절제후식관잔위화식관공장문합적료효.방법 회고성분석2009년7월지2011년2월제이군의대학부속장해의원수치적접수OrVilTM장치재복강경하진행소화도중건적34례위종류환자적림상자료.수술채용4공법,재완성림파결청소이급식관유리후,선횡단식관;연후재식관단단개구,장함OrVilTM장치적위관종해개구천출,병장저정좌대인복강;최후재복강경감시하,재체내완성식관잔위혹식관공장문합.결과 34례환자수술순리,무중전개복.기중32례경구강방치OrVilTM장치순리;2례경구강방치OrVilTM장치곤난,경방도환자기관삽관기낭내적기체병장기두부후앙후순리방치.34례환자평균수술시간위175 min(90～240 min);술중평균출혈량위196 ml(50～800 ml);술후평균주원시간위7.6 d(5～14 d);술후위장공능평균회복시간위3 d(2～6 d),병개시진식류질음식화하상활동.술후미출현문합구루.33례환자획득수방,평균수방시간위(10±6)개월(2～20개월),무종류복발화전이발생.결론 OrVilTM장치개변료이왕저정좌적치입방향,저일기술가이피면개흉수술,강저복강경하소화도중건적조작난도,축단수술시문.
Objective To investigate the efficacy of transorally inserted anvil system(OrVilTM)in esophagogastrostomy and esophagojejunostomy after laparoscopic gastrectomy.Methods The clinical data of 34 patients with gastric neoplasms who were installed OrVilTM for esophagogastrostomy or esophagojejunostomy at the Changhai Hospital from July 2009 to February 2011 were retrospectively analyzed.After radical dissection of lymph nodes and full mobilization of esophagus,the esophagus was transected and the anvil was then transorally inserted into the esophagus by using the OrVilTB system.Double-stapling esophagogastrustomy or esophagojejunostomy with a circular stapler Was performed intracorporeally under direct laparuscopic view.Results The surgery was success fully completed in all the 34 patients with no conversion to open surgery.Two patients had difficulty in placing OrVilTM system.and the condition Was alleviated by reducing tension in the cuff and tilting the head back.The mean operation time,volume of blood loss,duration of postoperative hospital stay and time to gastrointestinal function recovery were 175 minutes(range,90-240 minutes),196 ml(range,50-800 ml),7.6 days(range,5-14 days)and 3 days(range,2-6 days).No postoperative anastomotic leakage Was detected.Thirty-three patients were followed up for 2-20 months with a mean time of(10±6)months,and no tumor recurrence or metastasis occurred.Conclusion OrVilTM system changes insert direction of the anvil,which significantly reduces the difficulty of laparoscopic operation,shortens the operation time and avoids the thoracotomy.
