Du Jianjun, Liu Junjie, Zhao Lizhi, Jiang Haohai, Zhang Ziqiang
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, Shaanxi, 723000, China.
Langenbecks Arch Surg. 2024 Dec 16;410(1):9. doi: 10.1007/s00423-024-03571-x.
Laparoscopic total gastrectomy (LTG) is still limited because intracorporeal oesophagojejunostomy is technically demanding and difficult in laparoscopic gastrectomy. Circular-stapled anastomosis is considered the "gold standard" method for oesophagojejunostomy in open total gastrectomy. A purse-string suture instrument is used to create a purse-string suture along the distal oesophagus as a standard technique for classic circular-stapled oesophagojejunostomy in the open total gastrectomy. However, a simple and optimal laparoscopic purse-string suture device or instrument with an appropriate and optimal tube in the abdomen remains to be developed as a standard procedure for simple intracorporeal oesophagojejunostomy.
Between May 2023 and October 2023, a new laparoscopic purse-string suture clamp (Lap-PSC) and multi-functional seal cap (MSC) were applied to obtain a simple intracorporeal circular-stapled oesophagojejunostomy after laparoscopic total gastrectomy in 21 patients with gastric cancer in our hospital. The surgical details and postoperative outcomes were analyzed to evaluate this method.
The mean operation time was 203.8 ± 39.1 min. The mean time for the purse-string suture was 6.6 ± 2.8 min. An average of 13 min was required for purse-string creation and anvil placement. Tumor-free margins were obtained in 21 patients, with a median proximal margin length of 2 cm (range, 1.5-5 cm). Four postoperative complications occurred in this study. There was no mortality. During the median follow-up periods of 11 months, no anastomosis-related complications were observed.
The standardized single-stapling end-to-side oesophagojejunostomy in open surgery can be easily and safely performed during LTG using both Lap-PSC and MSC. The procedure using Lap-PSC with MSC may be considered as a better procedure to option in LTG.
腹腔镜全胃切除术（LTG）仍受到限制，因为在腹腔镜胃切除术中，体内食管空肠吻合术技术要求高且难度大。圆形吻合器吻合被认为是开放全胃切除术中食管空肠吻合的“金标准”方法。在开放全胃切除术中，荷包缝合器械用于沿食管远端进行荷包缝合，作为经典圆形吻合器食管空肠吻合的标准技术。然而，一种简单且最佳的腹腔镜荷包缝合装置或器械，以及腹部合适且最佳的套管，仍有待开发，作为简单体内食管空肠吻合的标准程序。
2023年5月至2023年10月期间，我院对21例胃癌患者应用新型腹腔镜荷包缝合钳（Lap-PSC）和多功能密封帽（MSC），在腹腔镜全胃切除术后进行简单的体内圆形吻合器食管空肠吻合术。分析手术细节和术后结果以评估该方法。
平均手术时间为203.8±39.1分钟。荷包缝合的平均时间为6.6±2.8分钟。荷包制作和钉砧放置平均需要13分钟。21例患者均获得切缘无肿瘤，近端切缘长度中位数为2cm（范围1.5 - 5cm）。本研究发生4例术后并发症。无死亡病例。在中位随访11个月期间，未观察到与吻合相关的并发症。
使用Lap-PSC和MSC，在LTG期间可以轻松、安全地完成开放手术中标准化的单吻合器端侧食管空肠吻合术。使用Lap-PSC与MSC的手术方法可被认为是LTG中更好的选择。
