Tanimura Shinya, Higashino Masayuki, Fukunaga Yosuke, Takemura Masashi, Nishikawa Takayuki, Tanaka Yoshinori, Fujiwara Yushi, Osugi Harushi
Department of Gastroenterological Surgery, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan.
Surg Laparosc Endosc Percutan Tech. 2008 Feb;18(1):54-8. doi: 10.1097/SLE.0b013e3181568e63.
As the laparoscopic operations for gastric cancer have increased, the intracorporeal reconstruction of the digestive tract has received attention because the procedure offers a good visual field regardless of the patient's figure. We performed laparoscopic gastrectomies with regional lymph node dissection on 586 gastric cancer patients between March 1998 and June 2006: 465 distal gastrectomies, 42 proximal gastrectomies, and 79 total gastrectomies. Intracorporeal anastomosis was carried out in 303, 36, and 69 of the above cases, respectively. The intracorporeal Billroth 1 reconstruction was performed in 226 out of the 303 cases who underwent distal gastrectomy and intracorporeal anastomosis. The "triangulating stapling technique" (TST) that uses laparoscopic linear stapling devices was adopted for 196 of these 226 cases; in the remaining 30, circular stapling devices for conventional open gastrectomy (CEEA) were used. In the initial 115 cases of distal gastrectomy, hand-assisted laparoscopic surgery (HALS) was used, and then we shifted to totally laparoscopic distal gastrectomy (TLDG) without HALS. In this paper, we concentrated on the techniques and results of intracorporeal Billroth 1 reconstruction by TST. Reducing postoperative wounds was possible TLDG by TST, compared with HALS and the extracorporeal anastomosis, that is, laparoscopy-assisted distal gastrectomy. Complications from anastomosis resulted in leakage in 2 HALS-TST patients and in 1 TLDG-TST patient, and anastomotic stenosis and bleeding were observed in each 1 case of reconstruction that used CEEA. Intracorporeal Billroth 1 reconstruction by TST is a safe procedure that provides a good visual field regardless of the patient's figure and a feasible technique for reconstruction after laparoscopic distal gastrectomies.
随着胃癌腹腔镜手术的增加，消化道的体内重建受到关注，因为无论患者体型如何，该手术都能提供良好的视野。1998年3月至2006年6月期间，我们对586例胃癌患者进行了腹腔镜胃切除术及区域淋巴结清扫术：465例远端胃切除术，42例近端胃切除术，79例全胃切除术。上述病例中分别有303例、36例和69例进行了体内吻合。在303例接受远端胃切除术并进行体内吻合的病例中，有226例进行了体内毕Ⅰ式重建。在这226例病例中，有196例采用了使用腹腔镜直线缝合器的“三角缝合技术”（TST）；其余30例使用了传统开放胃切除术的圆形缝合器（CEEA）。在最初的115例远端胃切除术中，采用了手辅助腹腔镜手术（HALS），然后我们转向了无HALS的完全腹腔镜远端胃切除术（TLDG）。在本文中，我们重点关注了通过TST进行体内毕Ⅰ式重建的技术和结果。与HALS及体外吻合（即腹腔镜辅助远端胃切除术）相比，通过TST进行TLDG可减少术后伤口。吻合口并发症导致2例HALS-TST患者和1例TLDG-TST患者出现渗漏，在使用CEEA进行重建的病例中，各有1例出现吻合口狭窄和出血。通过TST进行体内毕Ⅰ式重建是一种安全的手术，无论患者体型如何都能提供良好的视野，并且是腹腔镜远端胃切除术后可行的重建技术。
