Hyung Woo Jin, Song Changsoo, Cheong Jae Ho, Choi Seung Ho, Noh Sung Hoon
Department of Surgery, Yonsei University College of Medicine, 134 Shinchon- dong, Seodaemun-gu, Seoul 120-752, Korea.
Yonsei Med J. 2005 Oct 31;46(5):648-51. doi: 10.3349/ymj.2005.46.5.648.
Laparoscopic gastric surgeries are routinely performed with use of a nasogastric tube to decompress the upper gastrointestinal tract. A distended upper gastrointestinal tract can complicate successful laparoscopic gastric surgery as the distention compromises not only the visual field but also the laparoscopic manipulation of the stomach. Since nasogastric intubation is not without risks, we have attempted laparoscopic-assisted gastric cancer surgeries without nasogastric tubes. In this article we describe a simple method of aspirating gastric contents using a 9 cm long 19-gauge needle inserted percutaneously during laparoscopic-assisted gastrectomy. First, a 9 cm long 19-gauge disposable needle was introduced through the abdominal wall. This needle was then introduced to the stomach through the anterior wall and the stomach gases and fluids were aspirated by connecting the needle to suction. Thus, a collapsed upper gastrointestinal tract was easily obtained. We performed this procedure instead of nasogastric decompression on twenty-two patients with gastric cancer who underwent laparoscopic-assisted distal subtotal gastrectomy with lymph node dissection. The results were good with only one patient experiencing wound infection (4.5%) and one patient with postoperative acalculus cholecystitis (4.5%). There were no patients with either intraabdominal infection or anastomotic leakage and none of the patients needed postoperative nasogastric decompression, except the patient who experienced acaculus cholecystitis. Percutaneous needle aspiration is a very simple and efficient technique with little risk of postoperative complications. It can be used as an alternative to nasogastric tube decompression of the gastrointestinal tract for laparoscopic-assisted gastrectomy.
腹腔镜胃手术通常会使用鼻胃管来对上消化道进行减压。扩张的上消化道会使腹腔镜胃手术的成功变得复杂，因为这种扩张不仅会影响视野，还会妨碍对胃的腹腔镜操作。由于鼻胃管插管并非毫无风险，我们尝试了在不使用鼻胃管的情况下进行腹腔镜辅助胃癌手术。在本文中，我们描述了一种在腹腔镜辅助胃切除术中经皮插入一根9厘米长的19号针头来抽吸胃内容物的简单方法。首先，将一根9厘米长的19号一次性针头经腹壁插入。然后将该针头经前壁插入胃内，通过连接针头与吸引装置来抽吸胃内的气体和液体。这样，就很容易使上消化道塌陷。我们对22例行腹腔镜辅助远端胃大部切除术并清扫淋巴结的胃癌患者采用了这种方法来替代鼻胃管减压。结果良好，仅有1例患者发生伤口感染（4.5%），1例患者发生术后无结石性胆囊炎（4.5%）。没有患者发生腹腔内感染或吻合口漏，除了发生无结石性胆囊炎的患者外，没有患者需要术后鼻胃管减压。经皮针头抽吸是一种非常简单且有效的技术，术后并发症风险很小。它可作为腹腔镜辅助胃切除术时胃肠道鼻胃管减压的替代方法。
