Department of General Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, China.
Department of Digestive Surgery, Hanzhong Central Hospital, No. 22 Kangfu Road, Hanzhong, 723000, Shaanxi, China.
Surg Endosc. 2020 Nov;34(11):5181-5187. doi: 10.1007/s00464-020-07824-w. Epub 2020 Jul 22.
The double-tract reconstruction (DTR) could be a preferable option in avoiding the postoperative esophageal reflux and anastomotic stenosis during totally laparoscopic proximal gastrectomy (TLPG). An optimal procedure to achieve the DTR in TLPG remains to be established.
During March 2018 to April 2019, 15 consecutive patients with gastric cancer in the upper third of the stomach underwent intracorporeal DTR after TLPG at our hospital. The intracorporeal esophagojejunostomy (E-J), gastrojejunostomy (G-J) and jejunojejunostomy (J-J) were, respectively, performed using circular staplers by the Self-Pulling and Holding Purse-String Suture Technique, Intraluminal Poke Technique and U-shaped Parallel Purse-string Suture Technique (Technical Tie-Up). Demographic and clinicopathologic characteristics, perioperative details and postoperative outcomes were analyzed.
The mean operating time was 216.1 ± 18.2 min. Total time for three anastomoses was 49.8 ± 6.1 min, and the time for E-J, G-J, J-J was 22.4 ± 5.0 min, 13 (range 11-16) min, 14.2 ± 2.8 min, respectively. The median proximal and distal resection margins were 2.5 (range 2-4) cm and 6 (range 5-7) cm, respectively, which were all tumor-free in 15 patients. No major complications and mortality occurred. During the median follow-up period of 14 months (range 7 to 20.5 months), there were no postoperative anastomosis-related complications observed, such as anastomotic bleeding, leakage or stenosis. No patients complained the symptoms indicating esophageal reflux and remnant gastritis.
Predominant classic circular-stapled double-tract reconstruction is safe, feasible and time-saving in TLPG by the technical tie-up.
在全腹腔镜近端胃切除术（TLPG）中，双道重建（DTR）可以是避免术后食管反流和吻合口狭窄的首选方法。在 TLPG 中实现 DTR 的最佳方法仍有待建立。
2018 年 3 月至 2019 年 4 月，我院连续 15 例胃上部癌患者行 TLPG 后行腔内 DTR。腔内食管空肠吻合术（E-J）、胃空肠吻合术（G-J）和空肠空肠吻合术（J-J）分别采用自拉持荷包缝合技术、腔内穿刺技术和 U 形平行荷包缝合技术（技术结扎）进行圆形吻合器。分析了患者的一般资料、临床病理特征、围手术期资料和术后结果。
平均手术时间为 216.1±18.2 分钟。三个吻合口的总时间为 49.8±6.1 分钟，E-J、G-J、J-J 的时间分别为 22.4±5.0 分钟、13（11-16）分钟、14.2±2.8 分钟。近端和远端切缘的中位数分别为 2.5（2-4）cm 和 6（5-7）cm，15 例患者均无肿瘤。无重大并发症和死亡。在中位随访 14 个月（7-20.5 个月）期间，未观察到术后吻合口相关并发症，如吻合口出血、漏或狭窄。无患者出现提示食管反流和残胃炎的症状。
通过技术结扎，经典的圆形吻合器双道重建在 TLPG 中是安全、可行和省时的。
