CAJ | 학술논문

目的：探讨自行设计的空肠－腹壁联合荷包技术在微创食管癌手术同期行腹腔镜空肠穿刺造瘘术的可行性，及造瘘管在术后营养支持中的应用价值。方法腹腔镜下采用穿刺技术完成腹壁肌层－肠壁浆肌层联合荷包缝合，于缝合环线中置入F9空肠造瘘管，收紧缝线，皮下打结。结果24例均在腹腔镜下完成，平均操作时间8 min（4～20 min）。术中穿刺针贯穿肠壁1例，造瘘管脱落2例，造瘘管堵塞1例，手术并发症发生率16．7％（4／24）。术后营养支持中仅1例不能耐受，拔除造瘘管；其余患者带管至完成第1次或第2次化疗，进食量达平时量70％以上后拔除，平均保留时间为28 d（8～56 d）。2例腹胀，腹痛2例，无肠坏死、肠梗阻、肠扭转、腹膜炎等并发症，经调整治疗后缓解。结论腹腔镜联合荷包空肠穿刺造瘘术操作简便、安全有效，能提供早期、长时的肠内营养支持，对食管癌术后营养支持有重要应用价值。
목적：탐토자행설계적공장－복벽연합하포기술재미창식관암수술동기행복강경공장천자조루술적가행성，급조루관재술후영양지지중적응용개치。방법복강경하채용천자기술완성복벽기층－장벽장기층연합하포봉합，우봉합배선중치입F9공장조루관，수긴봉선，피하타결。결과24례균재복강경하완성，평균조작시간8 min（4～20 min）。술중천자침관천장벽1례，조루관탈락2례，조루관도새1례，수술병발증발생솔16．7％（4／24）。술후영양지지중부1례불능내수，발제조루관；기여환자대관지완성제1차혹제2차화료，진식량체평시량70％이상후발제，평균보류시간위28 d（8～56 d）。2례복창，복통2례，무장배사、장경조、장뉴전、복막염등병발증，경조정치료후완해。결론복강경연합하포공장천자조루술조작간편、안전유효，능제공조기、장시적장내영양지지，대식관암술후영양지지유중요응용개치。
Objective To explore the feasibility and clinical significance of a self-designed jenunum-abdominal wall purse suture technique in radical esophagectomy combined with laparoscopic jejunostomy . Methods A laparoscopic combined purse suture was performed to link the abdominal wall with the intestinal seromuscular layer under puncture techniques .In the central area of the purse suture , a F9 needle catheter was placed properly into the intestinal lumina for at least 30 cm, and then the purse suture was fastened and knotted underneath the belly skin . Results The laparoscopic procedure was completed in all the 24 patients, with a mean performance time of 8 min (4-20 min).The ratio of surgical-related complications was 16.7%(4/24).Except 1 patient was given catheter removal due to intolerance to enteral nutrition support , all the patients received planned postoperative enteral nutrition support.The tube was maintained for an average of 28 days (8-56 days) until the accomplishment of the first or second chemotherapy as well as 70% of the intake of diet amount .The complication associated with the nutrition support was abdominal distension in 2 cases.No intestinal necrosis, intestinal obstruction, intestinal twist, or peritonitis occurred. Conclusion Laparoscopic jejunostomy with purse suture is a technically feasible , safe, and effective way for nutritional support in the early phase after esophagectomy .