Department of General Surgery, Shanghai Fifth People's Hospital, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China.
Minimally Invasive Gastrointestinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
Surg Endosc. 2017 Nov;31(11):4773-4779. doi: 10.1007/s00464-017-5554-5. Epub 2017 Apr 13.
Laparoscopic total gastrectomy (LTG) is frequently performed for treating patients with gastric cancer; however, the absence of anastomotic techniques with greater superiority has impaired its popularization. We have compared two types of anastomotic techniques with regard to technical perspectives and clinical outcomes.
We reviewed 43 patients with gastric cancer who underwent LTG. Two types of anastomotic techniques have been applied after LTG-the trans-orally inserted anvil (OrVil™) and the reverse puncture device (RPD). Data on the type of anastomosis, blood loss, operation time, anastomosis time, location of tumors, distance between the top border of tumors and top resection margin, diameter of tumor, length of postoperative hospital stay, early and late postoperative complications, and total cost of surgical consumables were obtained by reviewing patient medical records and analyzed thereafter.
We included 32 men and 11 women (mean age 61 years). The loss to follow-up rate was 13.2%. The median survival time for the OrVil™ and RPD groups was 23 and 22 months, respectively. The total rate of complications was 9.3%. The difference in the anastomosis times between the groups was statistically significant. OrVil™ required more time than RPD and cost more than RPD.
Both the OrVil™ and RPD techniques showed good safety and applicability in LTG. RPD showed an advantage with regard to lesser operative complexity and lower cost.
腹腔镜全胃切除术（LTG）常用于治疗胃癌患者；然而，由于缺乏更优越的吻合技术，其推广受到了阻碍。我们从技术角度和临床结果两方面比较了两种吻合技术。
我们回顾了 43 例接受 LTG 的胃癌患者。在 LTG 后应用了两种吻合技术——经口置入吻合器（OrVil™）和反向穿刺装置（RPD）。通过查阅病历获得吻合类型、出血量、手术时间、吻合时间、肿瘤位置、肿瘤上缘与上切缘的距离、肿瘤直径、术后住院时间、早期和晚期术后并发症以及手术耗材总费用等数据，并进行了分析。
共纳入 32 名男性和 11 名女性（平均年龄 61 岁），失访率为 13.2%。OrVil™组和 RPD 组的中位生存时间分别为 23 个月和 22 个月。总的并发症发生率为 9.3%。两组吻合时间的差异有统计学意义。OrVil™组所需时间长于 RPD 组，费用也高于 RPD 组。
OrVil™和 RPD 两种技术在 LTG 中均表现出良好的安全性和适用性。RPD 在操作复杂性和成本方面具有优势。
