Chong-Wei Ke, Dan-Lei Chen, Dan Ding
Department of Gastrointestinal Surgery & Minimally Invasive Surgery, Changhai Hospital, Shanghai, China.
Surg Laparosc Endosc Percutan Tech. 2013 Jun;23(3):e109-15. doi: 10.1097/SLE.0b013e31828e3939.
Reconstruction of the digestive tract involving esophageal anastomosis after laparoscopic gastrectomy is a surgically difficult procedure. In this study, a newly developed transoral pretilted circular anvil, a "the oral to the abdomen" method, was proven to be effective.
A total of 34 consecutive patients underwent esophageal anastomosis using the OrVil in our hospital from July 2009 to February 2011. The esophagus was transected and a small hole was then made in the esophageal stump through which the nasogastric tube of the OrVil was passed to insert the anvil into the abdominal cavity. After fixation with a stapler and a glove at the jejunal loop or the remnant stomach, the abdominal cavity was entered through the minilaparotomy. Pneumoperitoneum and airtightness were reestablished after the glove edge was turned over to seal off the protector. Eventually, intracorporeal esophagojejunostomy or esophagogastrostomy was accomplished under the guidance of laparoscopy.
There were 34 patients in the study: 1 with Zollinger-Ellison syndrome, 7 with stromal tumors in cardia, 23 with adenocarcinoma in the stomach, and 3 with cardia adenocarcinoma involving the lower esophagus. The surgical margins for all tumor patients were negative for tumor cells. The mean operative time was 175.0 minutes (90 to 240 min) and the mean intraoperative blood loss was 195.6 mL (50 to 800 mL). The 34 patients underwent successful laparoscopic surgeries with no open conversions. For 32 patients, there were no technological complications in the transoral insertion of the anvil to the esophageal stump. There were no anastomotic leaks after the surgery.
The use of the OrVil device, a "the oral to the abdomen" method, changes the direction of the anvil insertion and significantly decreases both difficulty and duration of the laparoscopic surgery. More importantly, if the mass is at a higher position, this approach can achieve a higher surgical margin compared with the hand-sewn purse-string suture technique, thus avoiding the need to undergo a thoracotomy (Supplemental Digital Content 1, http://links.lww.com/SLE/A83).
腹腔镜胃切除术后涉及食管吻合的消化道重建是一项手术难度较大的操作。在本研究中，一种新开发的经口预倾斜圆形吻合器砧座，即“从口腔到腹部”的方法，被证明是有效的。
2009年7月至2011年2月，我院共有34例连续患者使用OrVil进行食管吻合。切断食管，然后在食管残端开一个小孔，将OrVil的鼻胃管通过该孔插入腹腔。在空肠袢或残胃处用吻合器和手套固定后，通过小切口进入腹腔。将手套边缘翻转以封闭保护器后，重新建立气腹和密闭性。最终，在腹腔镜引导下完成体内食管空肠吻合术或食管胃吻合术。
本研究共34例患者：1例患有卓艾综合征，7例贲门部间质瘤，23例胃腺癌，3例累及食管下段的贲门腺癌。所有肿瘤患者的手术切缘均未发现肿瘤细胞。平均手术时间为175.0分钟（90至240分钟），平均术中出血量为195.6毫升（50至800毫升）。34例患者均成功完成腹腔镜手术，无中转开腹。32例患者经口将吻合器砧座插入食管残端无技术并发症。术后无吻合口漏。
使用OrVil装置，即“从口腔到腹部”的方法，改变了吻合器砧座的插入方向，显著降低了腹腔镜手术的难度和持续时间。更重要的是，如果肿物位置较高，与手工缝合荷包缝合技术相比，这种方法可以获得更高的手术切缘，从而避免了开胸手术的需要（补充数字内容1，http://links.lww.com/SLE/A83）。
