腹腔镜全胃切除术治疗胃癌行食管空肠吻合术相关的技术风险和生存风险
Technical and Survival Risks Associated With Esophagojejunostomy by Laparoscopic Total Gastrectomy for Gastric Carcinoma.
作者信息
Yamamoto Manabu, Kawano Hiroyuki, Yamaguchi Shohei, Egashira Akinori, Minami Kazuhito, Morita Masaru, Sakaguchi Yoshihisa, Toh Yasushi
机构信息
*Department of Gastroenterological Surgery, National Kyushu Cancer Center, Minami-ku, Fukuoka †Department of Gastroenterological Surgery, National Kyushu Medical Center, Chuo-ku, Japan.
出版信息
Surg Laparosc Endosc Percutan Tech. 2017 Jun;27(3):197-202. doi: 10.1097/SLE.0000000000000409.
BACKGROUND
We performed esophagojejunostomy after totally laparoscopic total gastrectomy (TLTG) using functional end-to-end anastomosis (FEEA) as the first choice and laparoscopic-assisted total gastrectomy (LATG) using a circular stapler with a transorally inserted anvil as the second choice.
PATIENTS AND METHODS
We examined 109 patients with gastric cancer who underwent TLTG and LATG. Among these, 100 patients underwent TLTG and the rest underwent LATG.
RESULTS
The length of resected esophageal segment in LATG patients was significantly longer than that in TLTG patients (P<0.001). The length of the resected esophagus segment was inversely correlated with body mass index in cases of esophagojejunostomy by FEEA (P<0.05). Multivariate analysis revealed that T factor, N factor, and severe complications were the independent factors for survival.
CONCLUSIONS
Esophagojejunostomy using FEEA or a circular stapler with a transorally inserted anvil should be selected according to the length of the resected esophageal segment and/or body mass index.
背景
我们在全腹腔镜全胃切除术（TLTG）后采用功能性端端吻合术（FEEA）作为首选进行食管空肠吻合术，以及在腹腔镜辅助全胃切除术（LATG）后使用经口插入砧座的圆形吻合器作为次选进行食管空肠吻合术。
患者与方法
我们检查了109例行TLTG和LATG的胃癌患者。其中，100例患者接受了TLTG，其余患者接受了LATG。
结果
LATG患者切除的食管段长度明显长于TLTG患者（P<0.001）。在采用FEEA进行食管空肠吻合的病例中，切除的食管段长度与体重指数呈负相关（P<0.05）。多因素分析显示，T因素、N因素和严重并发症是生存的独立因素。
结论
应根据切除的食管段长度和/或体重指数选择采用FEEA或经口插入砧座的圆形吻合器进行食管空肠吻合术。
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