Kong Seong-Ho, Suh Yunsuhk, Kwon Sebastianus, Lee Hyuk-Joon, Kim Hyung-Ho, Yang Han-Kwang
Department of Surgery, Seoul National University Hospital, Seoul, Korea.
Asian J Endosc Surg. 2013 May;6(2):82-9. doi: 10.1111/ases.12014. Epub 2013 Jan 17.
During a laparoscopic total gastrectomy, the combined process of purse-string suture placement and anvil insertion of a circular stapler is one of the most difficult steps in the reconstruction. We have developed a stable and reliable technique in which purse-string suture placement and anvil insertion using anterior esophagotomy precede complete transection of the esophagus.
The procedure involves tying the distal esophagus, insufflating the esophagus via a nasogastric tube, anterior wall purse-string suture, anterior esophagotomy, posterior wall purse-string suture, anvil insertion, fastening purse-string suture, and transecting the esophagus. The technique has been employed in nine patients since April 2011.
Eight of the nine gastrectomies were for patients with stage IA early gastric cancer and one was for a patient with medically intractable bleeding from multiple polyps. Three were men and six were women. Average BMI was 25.2 ± 5.3 (range, 16.3-33.9). Mean operation time was 276.2 ± 56.3 min (range, 215.0-395.0 min) and the mean duration for anvil insertion was 29.8 ± 7.0 min (range, 23.0-46.0 min). There were no intraoperative or postoperative anastomosis-related complications or mortality.
Our method of anvil insertion of a circular stapler can be a good option for safe and reliable esophagojejunostomy during a laparoscopic total gastrectomy.
在腹腔镜全胃切除术中，荷包缝合放置和圆形吻合器钉砧插入的联合操作是重建过程中最困难的步骤之一。我们开发了一种稳定可靠的技术，即在食管完全横断之前，先进行荷包缝合放置和经食管前壁切口插入钉砧。
该手术包括结扎食管远端、经鼻胃管向食管内注入气体、食管前壁荷包缝合、食管前壁切开、食管后壁荷包缝合、钉砧插入、收紧荷包缝合以及横断食管。自2011年4月以来，该技术已应用于9例患者。
9例胃切除术中，8例为IA期早期胃癌患者，1例为多发性息肉导致的内科治疗难以控制的出血患者。男性3例，女性6例。平均体重指数为25.2±5.3（范围16.3 - 33.9）。平均手术时间为276.2±56.3分钟（范围215.0 - 395.0分钟），钉砧插入的平均持续时间为29.8±7.0分钟（范围23.0 - 46.0分钟）。术中及术后均未出现与吻合相关的并发症或死亡。
我们的圆形吻合器钉砧插入方法对于腹腔镜全胃切除术中安全可靠的食管空肠吻合术可能是一个不错的选择。
