腹腔镜全胃切除术中体内圆形吻合器食管空肠吻合术的一种新选择：Roux-en-Y重建，其输出袢位于患者左侧，以防止食管空肠吻合口扭转。
A new option for intracorporeal circular-stapled esophagojejunostomy in laparoscopic total gastrectomy: Roux-en-Y reconstruction with its efferent loop located at the left side of the patient to prevent twisting of the esophagojejunostomy.
作者信息
Tokuhara Takaya, Nakata Eiji, Tenjo Toshiyuki, Kawai Isao, Satoi Syunpei, Inoue Keisuke, Araki Mariko, Ueda Hirofumi
出版信息
Hepatogastroenterology. 2015 Mar-Apr;62(138):551-4.
BACKGROUND/AIMS: Laparoscopic total gastrectomy (LTG) has not gained widespread acceptance because of the difficult reconstruction technique, especially for esophagojejunostomy. Although various modified procedures using a circular stapler for esophagojejunostomy have been reported, an optimal technique has not yet been established. In addition, in intracorporeal techniques, twisting of the esophagojejunostomy, which might be the cause of stenosis, is often encountered because application of the shaft is restricted. To prevent twisting of the esophagoejunostomy, we underwent LTG with Roux-en-Y reconstruction with its efferent loop located at the left side of the patient.
METHODOLOGY
From November 2013 to November 2014, a series of 9 patients underwent LTG with Roux-en-Y reconstruction using the transorally inserted anvil (OrVil™, Covidien, Mansfield, MA, USA), whose efferent loop was located at the left side of the patient.
RESULTS
No twisting of the esophagojejunostomy was encountered in all cases. In addition, no stenosis or leakage of the esophagojejunostomy occurred.
CONCLUSIONS
This reconstruction system may be a feasible surgical procedure in LTG.
背景/目的：腹腔镜全胃切除术（LTG）由于重建技术困难，尤其是食管空肠吻合术，尚未得到广泛认可。尽管已经报道了各种使用圆形吻合器进行食管空肠吻合术的改良方法，但尚未确立最佳技术。此外，在体内技术中，由于吻合器杆的应用受限，经常会遇到食管空肠吻合口扭转，这可能是狭窄的原因。为防止食管空肠吻合口扭转，我们对患者进行了 Roux-en-Y 重建的 LTG，其输出袢位于患者左侧。
方法
2013 年 11 月至 2014 年 11 月，9 例患者接受了使用经口插入砧座（OrVil™，美国科惠医疗，马萨诸塞州曼斯菲尔德）进行 Roux-en-Y 重建的 LTG，其输出袢位于患者左侧。
结果
所有病例均未出现食管空肠吻合口扭转。此外，未发生食管空肠吻合口狭窄或渗漏。
结论
这种重建系统可能是 LTG 中一种可行的手术方法。
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