CAJ | 학술논문

目的：探讨直线切割闭合器在全腹腔镜下胃肠 Roux-en-Y 吻合中应用的可行性与安全性。方法回顾性分析2011年11月至2014年2月间在首都医科大学附属北京天坛医院普通外科全腹腔镜下21例胃远端切除患者的临床和随访资料，其中消化道重建全部采用了使用直线切割闭合器胃肠 Roux-en-Y 吻合。结果所有病例均顺利完成手术，无中转开腹。20例逆蠕动胃肠 Roux-en-Y吻合时间25~40（32.1±5.5）min，1例顺蠕动胃肠 Roux-en-Y 吻合时间为35 min。1例逆蠕动胃肠 Roux-en-Y 吻合患者术后第4天进食，术后6 d 出现胃排空障碍，经保守治疗术后12 d 缓解。其余患者围手术期未出现吻合口出血、瘘、狭窄（梗阻）等并发症。术后随访2周~27个月，1例术后5.5个月因小肠侧侧吻合口狭窄再次开腹手术，其余未见吻合口相关的并发症。结论直线切割闭合器在全腹腔镜胃肠Roux-en-Y 吻合中应用，避免了镜下缝合操作，具有操作简单、易于掌握、安全等特点。
목적：탐토직선절할폐합기재전복강경하위장 Roux-en-Y 문합중응용적가행성여안전성。방법회고성분석2011년11월지2014년2월간재수도의과대학부속북경천단의원보통외과전복강경하21례위원단절제환자적림상화수방자료，기중소화도중건전부채용료사용직선절할폐합기위장 Roux-en-Y 문합。결과소유병례균순리완성수술，무중전개복。20례역연동위장 Roux-en-Y문합시간25~40（32.1±5.5）min，1례순연동위장 Roux-en-Y 문합시간위35 min。1례역연동위장 Roux-en-Y 문합환자술후제4천진식，술후6 d 출현위배공장애，경보수치료술후12 d 완해。기여환자위수술기미출현문합구출혈、루、협착（경조）등병발증。술후수방2주~27개월，1례술후5.5개월인소장측측문합구협착재차개복수술，기여미견문합구상관적병발증。결론직선절할폐합기재전복강경위장Roux-en-Y 문합중응용，피면료경하봉합조작，구유조작간단、역우장악、안전등특점。
Objective To explore the feasibility and safety of the application of stapler in total laparoscopic gastrointestinal Roux-en-Y anastomosis. Methods The files of 21 patients undergoing total laparoscopic gastrointestinal Roux-en-Y anastomosis with stapler from November 2011 to February 2014 were analyzed retrospectively, in general surgery, Beijing Tiantan Hospital affiliated to Capital Medical University. Results All cases were successfully completed, without conversion to laparotomy. The mean time of antiperistaltic gastrointestinal Roux-en-Y anastomosis was 25~40 (32.1±5.5)min in 20 cases, 35 min in one case performed iso-peristaltic gastrointestinal Roux-en-Y anastomosis. One case started eating on the 4th day after operation,with delayed gastric emptying 6th day,in remission through conservative treatment 12th day. There were not anastomotic bleeding, fistula, stenosis (obstruction) and other complications in the other patients beyond the perioperative phase. During all cases followed up for 2 weeks to 27 months, one case performed laparotomy again due to stricture of side to side anastomosis of small intestine after 5.5 months. The others had no anastomotic complications. Conclusion It is the application of stapler in total laparoscopic gastrointestinal Roux-en-Y anastomosis that has the advantages of simple operation, easy to grasp and safty etc, avoids the laparoscopic suture.