Shoji Y, Nihei Z, Hirayama R, Mishima Y
Second Department of Surgery, Tokyo Medical and Dental University, Japan.
Surg Today. 1995;25(1):27-31. doi: 10.1007/BF00309381.
The use of stapling devices for performing gastro-intestinal anastomosis has recently gained wide acceptance. In fact, since 1991, we have been using linear cutter devices for performing the Roux-en-Y anastomosis, transection of the duodenum, and closure of the jejunal stump (except following esophagojejunostomy), and are no longer employing hand-sewn procedures. In this report, the linear cutter technique used after total gastrectomy is described and the differences in anastomotic leakage, morbidity, operating time, and reconstruction time are evaluated in comparison with those following hand-sewn anastomoses. A total of 22 patients undergoing total gastrectomy within a 2-year period were randomized into two groups of 11, to have reconstruction performed by either a stapled or hand-sewn Roux-en-Y anastomosis. One patient from the stapled group died of acute myocardial infarction 6 days after the operation. Anastomotic leakages from the esophagojejunostomy region occurred in 18% of the patients in the stapled group, but fortunately no leakage was apparent from the Y-anastomosis when the linear cutter technique was used. The most obvious significance was the short mean reconstruction time in the stapled group of 19.1 +/- 3.56 min (P < 0.01) being 31 min shorter than that of the hand-sewn group (n = 11). Thus, we proposed that the linear cutter technique is a safe technique for performing anastomosis following total gastrectomy, which would significantly reduce the reconstruction time.
使用吻合器进行胃肠吻合术最近已得到广泛认可。事实上，自1991年以来，我们一直在使用线性切割器进行Roux-en-Y吻合术、十二指肠横断术以及空肠残端闭合术（食管空肠吻合术除外），不再采用手工缝合方法。在本报告中，描述了全胃切除术后使用的线性切割器技术，并与手工缝合吻合术后的情况进行比较，评估吻合口漏、发病率、手术时间和重建时间的差异。在两年期间，共有22例行全胃切除术的患者被随机分为两组，每组11例，分别采用吻合器或手工缝合的Roux-en-Y吻合术进行重建。吻合器组有1例患者术后6天死于急性心肌梗死。吻合器组食管空肠吻合部位的吻合口漏发生率为18%，但幸运的是，使用线性切割器技术时，Y形吻合口未出现明显漏液。最显著的差异是吻合器组平均重建时间短，为19.1±3.56分钟（P<0.01），比手工缝合组（n = 11）短31分钟。因此，我们认为线性切割器技术是全胃切除术后进行吻合的一种安全技术，可显著缩短重建时间。
