摘要
目的探讨食管空肠手工吻合重建在完全腹腔镜全胃切除术(TLTG)中的应用价值。方法采用回顾性描述性研究方法。收集2018年7月至2019年12月上海交通大学医学院附属仁济医院收治的35例早期及进展期胃上部癌患者的临床病理资料;男24例,女11例;年龄为(60±10)岁,年龄范围为35~75岁。所有患者行TLTG+食管空肠手工吻合。观察指标:(1)术中情况。(2)术后情况。(3)术后病理学检查情况。(4)随访和生存情况。采用电话、门诊、短信、微信等方式进行随访,了解患者肿瘤复发转移情况和生存情况。随访时间截至2020年1月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。结果(1)术中情况:35例患者均完成TLTG+食管空肠手工吻合。35例患者手术时间为305 min(232~406 min),术中出血量为94 mL(50~300 mL),食管空肠手工吻合时间为37 min(20~65 min),术中切除及重建所需耗材费用为13674元(11929~15255元),食管空肠缝合所需耗材费用为491元(223~1044元)。35例患者中,4例术中输血。(2)术后情况:35例患者首次下床活动时间为2 d(1~3 d)、术后胃管留置时间为4 d(2~11 d)、首次进食流质食物时间为5 d(4~12 d)、拔除腹腔引流管时间为8 d(5~15 d),术后住院时间为9 d(7~16 d)。35例患者中,3例出现围术期并发症,其中1例出现胰尾部炎症感染,通过禁食、给予生长抑素减少胰液分泌、充分引流、抗感染、营养支持等保守治疗后,于术后第16天顺利出院;1例出现术后小肠不全梗阻,经过胃肠减压、灌肠等治疗解除梗阻症状后,于术后第12天出院;1例发生肺部感染,经对症支持治疗后于术后第9天出院。35例患者未发生围术期吻合口漏、出血等吻合口相关并发症。35例患者中,1例患者于术后2个月左右出现食管空肠吻合口狭窄,在内镜下扩张后好转。35例患者远期吻合口相关并发症
Objective To investigate the application value of hand⁃sewn esophagojejunal anastomosis(EJA)in totally laparoscopic total gastrectomy(TLTG).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 35 patients with early or advanced upper gastric cancer who were admitted to Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between July 2018 and December 2019 were collected.There were 24 males and 11 females,aged(60±10)years,with a range of 35-75 years.All the 35 patients underwent TLTG combined with hand⁃sewn EJA.Observation indicators:(1)intraoperative situations;(2)postoperative situations;(3)postoperative pathological examination;(4)follow⁃up and survival.Follow⁃up was conducted using telephone interview,outpatient examination,short message service and WeChat to detect tumor recurrence,metastasis and survival of patients up to January 2020.Measurement data with normal distribution were repressented as Mean±SD.Measurement data with skewed distribution were represented as M(range).Count data were expressed as absoulte numbers or persentages.Results(1)Intraoperative situations:all the 35 patients underwent TLTG combined with hand⁃sewn EJA successfully.The operation time,volume of intraoperative blood loss,time of hand⁃sewn EJA,costs of consumables used in the intraoperative resection and reconstruction,and costs of consumables used in EJA of the 35 patients were 305 minutes(range,232-406 minutes),94 mL(range,50-300 mL),37 minutes(range,20-65 minutes),13674 yuan(range,11929-15255 yuan)and 491 yuan(range,223-1044 yuan),respectively.Of the 35 patients,4 received intraoperative blood transfusion.(2)Postoperative situations:time to first out⁃of⁃bed activity,postoperative indwelling time of gastric tube,time to initial liquid diet intake,the time to abdominal drainage tube removal and duration of postoperative hospital stay of the 35 patients were 2 days(range,1-3 days),4 days(range,2-11 days),5 days(range,4-12 days),8 days(range,5-15 days
作者
马欣俐
徐佳
顾佳毅
杨琳希
赵恩昊
成功
曹晖
邱江锋
Ma Xinli;Xu Jia;Gu Jiayi;Yang Linxi;Zhao Enhao;Cheng Gong;Cao Hui;Qiu Jiangfeng(Department of Gastroenterology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2020年第6期680-685,共6页
Chinese Journal of Digestive Surgery
基金
上海市自然科学基金(16ZR1420500)。
关键词
胃肿瘤
全腹腔镜全胃切除术
食管空肠手工缝合
安全性
并发症
吻合口漏
腹腔镜检查
Gastric neoplasms
Totally laparoscopic total gastrectomy
Hand⁃sewn esophagojejunal anastomosis
Safety
Complication
Anastomotic leakage
Laparoscopy
