Okabe Hiroshi, Obama Kazutaka, Tanaka Eiji, Nomura Akinari, Kawamura Jun-ichiro, Nagayama Satoshi, Itami Atsushi, Watanabe Go, Kanaya Seiichiro, Sakai Yoshiharu
Department of Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Surg Endosc. 2009 Sep;23(9):2167-71. doi: 10.1007/s00464-008-9987-8. Epub 2008 Jun 14.
To facilitate acceptance of laparoscopic total gastrectomy (LTG) for patients with upper gastric cancer, a simple, secure technique of reconstruction is necessary. The authors developed a new technique for intracorporeal esophagojejunal anastomosis that does not require hand sewing.
From September 2006 to January 2008, 16 patients (11 men and 5 women) with gastric cancer underwent LTG at the authors' institution. Laparoscopic esophagojejunal anastomosis using the following method was attempted for all patients. The esophagus was transected while being rotated by about 45 degrees counterclockwise to make the subsequent anastomosis easier. After the Y-anastomosis was created, an endoscopic linear stapler was applied to create a side-to-side anastomosis between the left dorsal side of the esophagus and the jejunal limb. The entry hole was first closed roughly with hernia staplers. Subsequently, an endoscopic linear stapler was applied so that all hernia staplers could be removed and the closure completed.
Laparoscopic esophagojejunal anastomosis was successfully performed for 15 patients. Intracorporeal anastomosis failed for one patient because a nasogastric tube was caught between the jaws of an endostapler, which resulted in a conversion to open procedure. No postoperative anastomotic complications occurred.
Using the new technique, intracorporeal linear-stapled esophagojejunal anastomosis can be performed easily and securely. This technique could become one of the standard methods for reconstruction after LTG, facilitating the acceptance of LTG as a surgical option for patients with upper gastric cancer.
为了促进腹腔镜全胃切除术（LTG）被上段胃癌患者所接受，一种简单、安全的重建技术是必要的。作者开发了一种无需手工缝合的体内食管空肠吻合新技术。
2006年9月至2008年1月，16例（男11例，女5例）胃癌患者在作者所在机构接受了LTG。所有患者均尝试采用以下方法进行腹腔镜食管空肠吻合。在食管逆时针旋转约45度的同时将其切断，以便后续吻合更容易进行。在完成Y形吻合后，使用内镜直线切割吻合器在食管左背侧与空肠支之间进行侧侧吻合。首先用疝吻合器大致封闭入口孔。随后，应用内镜直线切割吻合器以便能够移除所有疝吻合器并完成封闭。
15例患者成功完成了腹腔镜食管空肠吻合。1例患者体内吻合失败，原因是鼻胃管夹在了吻合器的钳口之间，导致改为开放手术。术后未发生吻合口并发症。
使用新技术，体内直线切割吻合的食管空肠吻合可以轻松、安全地进行。该技术可能成为LTG术后重建的标准方法之一，有助于LTG被上段胃癌患者作为一种手术选择所接受。
