Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-0815, Japan,
Gastric Cancer. 2013 Oct;16(4):609-14. doi: 10.1007/s10120-012-0211-0. Epub 2012 Nov 22.
Laparoscopic esophagojejunostomy using a circular stapler is associated with technical difficulties in the purse-string sutures used to insert the anvil head and in obtaining an adequate visual field to prevent rolling the mesentery and the wall of the jejunum on the mesenteric side into the anastomosis. To overcome these difficulties, we used the EndoStitch to create the purse-string suture and the ENDOCAMELEON to create the visual field to stretch the jejunum. After resecting the esophagus, purse-string sutures were placed using the EndoStitch. A total of five to six needle deliveries were performed. Next, the anvil head was inserted into the esophagus. The main unit of the EEA was inserted from the end of the resected jejunum. Then, the scope was changed to the ENDOCAMELEON. The main unit was slowly moved toward the anvil head. After making sure that the mesentery and the wall of the jejunum on the mesenteric side were not rolled into the anastomosis under the visual field created by the ENDOCAMELEON, the main unit was then fired. Thereafter, esophagojejunostomy was successfully completed. This technique was applied in 20 patients between April 2010 and May 2012. Laparoscopic esophagojejunostomy after total gastrectomy for gastric cancer was completed in all 20 patients. No case required conversion to open surgery. Neither anastomotic leakage nor stenosis was observed. This method is simple and useful for laparoscopic esophagojejunostomy after total gastrectomy for gastric cancer.
使用圆形吻合器进行腹腔镜食管空肠吻合术时，在插入吻合器钉砧头和获得足够的视野以防止将系膜和空肠壁滚入吻合口方面存在技术困难。为了克服这些困难，我们使用 EndoStitch 来创建荷包缝线，并使用 ENDOCAMELEON 来创建视野以拉伸空肠。在切除食管后，使用 EndoStitch 放置荷包缝线。总共进行了五到六针的输送。然后，将吻合器钉砧头插入食管。从切除的空肠末端插入 EEA 的主单元。然后，将内镜更换为 ENDOCAMELEON。主单元缓慢移向吻合器钉砧头。在通过 ENDOCAMELEON 创建的视野下确认肠系膜和系膜侧空肠壁未卷入吻合口后，然后启动主单元。此后，成功完成食管空肠吻合术。该技术于 2010 年 4 月至 2012 年 5 月期间在 20 名患者中应用。在全胃切除术后，20 名患者均成功完成腹腔镜食管空肠吻合术。没有病例需要转为开放手术。没有观察到吻合口漏或狭窄。该方法简单且对于胃癌全胃切除术后的腹腔镜食管空肠吻合术很有用。
