CAJ | 학술논문

目的探讨反穿刺器(reverse puncture device,RPD)在腹腔镜食管-空肠吻合中的应用,探讨其可行性、安全性及临床效果。方法回顾性分析2011年3月至2012年12月接受腹腔镜下经膈肌裂孔全胃切除术治疗20例食管胃交界部腺癌病人的临床资料。所有病人均在腹腔镜下切开食管前壁,置入 RPD,完成食管-空肠吻合。结果本组20例病人均在腹腔镜下顺利完成手术,手术时间为(189.8±44.1)min,抵钉座放置时间为(15.6±3.5)min,吻合耗时(58.7±9.3)min,术中出血量为(275.6±36.1)ml,排气时间为(2.9±0.7)d,下床时间为(3.8±0.8)d,术后引流量为(252.8±31.0)ml,住院时间为(10.3±1.6)d。食管切缘距肿瘤近端(4.2± 1.0)cm,残端均无癌残留。围手术期无死亡病例,未发生吻合口瘘、吻合口狭窄、腹腔感染等并发症。20例病人均获随访,随访时间12~ 15 个月。术后1个月和3个月反流性疾病问卷表(reflux diagnostic questionnaire, RDQ)评分分别为(9.8±3.6)分和(9.1±2.9)分。随访期间发现1例病人吻合口狭窄,经扩张后缓解。结论抵钉座逆向置入食管能简单而安全地在下后纵隔完成食管-空肠吻合,可能成为食管胃交界部腺癌行全胃切除术后的一种较理想的吻合方式。
목적탐토반천자기(reverse puncture device,RPD)재복강경식관-공장문합중적응용,탐토기가행성、안전성급림상효과。방법회고성분석2011년3월지2012년12월접수복강경하경격기렬공전위절제술치료20례식관위교계부선암병인적림상자료。소유병인균재복강경하절개식관전벽,치입 RPD,완성식관-공장문합。결과본조20례병인균재복강경하순리완성수술,수술시간위(189.8±44.1)min,저정좌방치시간위(15.6±3.5)min,문합모시(58.7±9.3)min,술중출혈량위(275.6±36.1)ml,배기시간위(2.9±0.7)d,하상시간위(3.8±0.8)d,술후인류량위(252.8±31.0)ml,주원시간위(10.3±1.6)d。식관절연거종류근단(4.2± 1.0)cm,잔단균무암잔류。위수술기무사망병례,미발생문합구루、문합구협착、복강감염등병발증。20례병인균획수방,수방시간12~ 15 개 월。술후1개월화3개월반류성질병문권표(reflux diagnostic questionnaire, RDQ)평분분별위(9.8±3.6)분화(9.1±2.9)분。수방기간발현1례병인문합구협착,경확장후완해。결론저정좌역향치입식관능간단이안전지재하후종격완성식관-공장문합,가능성위식관위교계부선암행전위절제술후적일충교이상적문합방식。
Objective To explore the feasibility,safety and clinical efficacy of reverse puncture device (RPD) during esophagojejunostomy after laparoscopic total gastrectomy.Methods From March 201 1 to December 2012,20 cases of adenocarcinoma of esophagogastric junction underwent lap-aroscopic transhiatal total gastrectomy.And their clinical data were analyzed retrospectively.After laparoscopic total gastrectomy,anvil was transorally inserted into esophagus by RPD system.Results All procedures were completed laparoscopically.The mean operative duration was (1 89.8 ±44.1 ) min,mean time for RPD (1 5.6 ± 3.5 )min,mean operation duration for anastomotic (58.7 ± 9.3 ) min,mean estimated blood loss (275.6±36.1)ml,average flatus time (2.9±0.7)days,mean post-operative ambulatory time (3.8±0.8)days,mean drainage volume (252.8 ±3 1 .0)ml,mean hospi-talization stay (10.3 ± 1 .6)days and proximal resection margin (4.2 ± 1 .0)cm.All margins were negative for residual cancer.There was no postoperative onset of mortality,bleeding,anastomotic ste-nosis or wound infection.The follow-up period was 12-1 5 months.The value of reflux diagnostic questionnaire (RDQ)was 9.8±3.6 at 1 month and 9.1 ±2.9 at 3 months postoperatively.During fol-low-ups,one case of anastomotic stenosis was successfully managed by endoscopic balloon dilatation. Conclusions Esophagojejunostomy may be safely performed with reverse anvil insertion.And it is ide-al for anastomosis after total gastrectomy for esophagogastric junction carcinoma.