Chen Y, Xiong W W, Zheng Y S, Luo L J, Li J, Zhu X F, Luo S J, Xu Y T, Wan J, Wang W
Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China Department of Traditional Chinese Medicine Surgery, The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2022 Feb 25;25(2):173-178. doi: 10.3760/cma.j.cn441530-20210222-00075.
The study aimed to investigate the safety and feasibility of intrathoracic modified overlap method in laparoscopic radical resection of Siewert type II adenocarcinoma of the esophagogastric junction (AEG). A descriptive case series study was conducted. The clinical data of 27 patients with Siewert type II AEG who underwent transthoracic single-port assisted laparoscopic total gastrectomy and intrathoracic modified overlap esophagojejunostomy in Guangdong Provincial Hospital of Chinese Medicine from May 2017 to December 2020 were retrospectively analyzed. The intrathoracic modified overlap esophagojejunostomy was performed as follows: (1) The Roux-en-Y loop was made; (2) The jejunum side was prepared extraperitoneal for overlap anastomosis; (3) The esophagus side was prepared intraperitoneal for overlap anastomosis; (4) The overlap esophagojejunostomy was performed; (5) The common outlet was closed after confirmation of anastomosis integrity without bleeding; (6) A thoracic drainage tube was inserted into the thoracic hole with the diaphragm incision closed. The intraoperative and postoperative results were reviewed. All 27 patients were successfully operated, without mortality or conversion to laparotomy. The operative time, digestive tract reconstruction time and esophageal-jejunal anastomosis time were (327.5±102.0) minute, 50 (28-62) minute and (29.0±7.4) minute, respectively. The blood loss was 100 (20-150) ml. The postoperative time to flatus and postoperative hospital stay were (4.7±3.7) days and 9(6-73) days, respectively. Three patients (11.1%) developed postoperative grade III complications according to the Clavien-Dindo classification, including 1 case of anastomotic fistula with empyema, 1 case of pleural effusion and 1 case of pancreatic fistula, all of whom were cured by puncture drainage and anti-infective therapy. The intrathoracic modified overlap esophagojejunostomy is safe and feasible in laparoscopic radical resection of Siewert type II AEG.
本研究旨在探讨胸腔内改良重叠法在腹腔镜根治性切除食管胃交界部（AEG）Siewert II型腺癌中的安全性和可行性。进行了一项描述性病例系列研究。回顾性分析了2017年5月至2020年12月在广东省中医院接受经胸单孔辅助腹腔镜全胃切除术及胸腔内改良重叠食管空肠吻合术的27例Siewert II型AEG患者的临床资料。胸腔内改良重叠食管空肠吻合术的操作如下：（1）制作Roux-en-Y袢；（2）将空肠侧在腹膜外准备用于重叠吻合；（3）将食管侧在腹膜内准备用于重叠吻合；（4）进行重叠食管空肠吻合；（5）在确认吻合口完整无出血后关闭共同开口；（6）在关闭膈肌切口的胸壁孔处插入胸腔引流管。回顾了术中及术后结果。27例患者均成功手术，无死亡或中转开腹。手术时间、消化道重建时间和食管空肠吻合时间分别为（327.5±102.0）分钟、50（28 - 62）分钟和（29.0±7.4）分钟。出血量为100（20 - 150）ml。术后排气时间和术后住院时间分别为（4.7±3.7）天和9（6 - 73）天。根据Clavien-Dindo分类，3例患者（11.1%）发生术后III级并发症，包括1例吻合口瘘合并脓胸、1例胸腔积液和1例胰瘘，所有患者均经穿刺引流和抗感染治疗治愈。胸腔内改良重叠食管空肠吻合术在腹腔镜根治性切除Siewert II型AEG中是安全可行的。
