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首页> 外文期刊>Surgical Endoscopy >Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy.
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Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy.

机译：腹腔镜全胃切除术后采用手缝荷包缝合法进行体内循环吻合式食管空肠吻合术。

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BACKGROUND: Laparoscopic total gastrectomy (LTG) has not gained widespread acceptance because of technical difficulties, especially esophagojejunal anastomosis. Various modified procedures for reconstruction have been reported, but an optimal method has not been established. The authors report a circular-stapled anastomosis using hand-sewn purse-string sutures, which is a simple and classic method. However, no previous study has assessed its reliability. METHODS: From September 2008 to May 2009, 10 consecutive patients (9 men and 1 woman) with gastric cancer underwent LTG at the authors' institution. These patients had a median age of 63.7 years (range, 45-80 years) and a body mass index of 22.4 kg/m(2) (range, 18-26 kg/m(2)). After transection of the abdominal esophagus, a hand-sewn purse-string suture along the cut end of the esophagus was performed using 3-0 monofilament thread. An anvil head then was inserted into the esophagus, and the thread was tied. A monofilament pretied loop suture was added to reinforce the ligation. After the creation of an Roux-en-Y jejunal limb, laparoscopic esophagojejunal anastomosis was performed using a circular stapler inserted via a surgical glove attached to a wound retractor at the incision point at the umbilicus. The jejunal stump was closed with an endoscopic linear stapler. RESULTS: Laparoscopic esophagojejunostomy was performed successfully for all the patients. No postoperative complications related to anastomosis occurred. In one patient, an intraabdominal abscess developed postoperatively and was treated conservatively. The mean operation time was 257 min, and the estimated blood loss was 69 ml. CONCLUSIONS: With the described method, esophagojejunostomy can be performed as in conventional open surgery. Hand-sewn purse-string suturing is demanding technically, but it can be performed safely by experienced laparoscopic surgeons. This technique is feasible and can lower the cost of the laparoscopic procedure. It may be considered in countries with limited access to other special devices.
机译：背景：由于技术困难，尤其是食管空肠吻合术，腹腔镜全胃切除术（LTG）尚未得到广泛接受。已经报道了各种修改过的重建程序，但是尚未建立最佳方法。作者报告了使用手工缝制的荷包缝线缝合进行的吻合钉吻合术，这是一种简单而经典的方法。但是，以前没有研究评估其可靠性。方法：从2008年9月至2009年5月，作者所在机构连续接受胃癌患者10例（男9例，女1例）。这些患者的中位年龄为63.7岁（范围为45-80岁），体重指数为22.4 kg / m（2）（范围为18-26 kg / m（2））。横切腹部食道后，使用3-0单丝线沿食道的切割端进行手工缝制的荷包缝合线。然后将一个砧头插入食道，并绑好线。添加了单丝美发环缝线以加强结扎。在创建Roux-en-Y空肠肢体后，使用圆形吻合器进行腹腔镜食管空肠吻合，该吻合器是通过外科手套插入的，该外科手套连接到脐带切口处的伤口牵开器。用内窥镜线性吻合器封闭空肠残端。结果：所有患者均成功进行了腹腔镜食管空肠吻合术。没有发生与吻合相关的术后并发症。一名患者术后出现腹腔脓肿，并接受了保守治疗。平均手术时间为257分钟，估计失血量为69毫升。结论：采用上述方法，可以像常规开放手术一样进行食管空肠吻合术。手工缝制的钱包线缝合在技术上要求很高，但经验丰富的腹腔镜外科医生可以安全地进行缝合。该技术是可行的并且可以降低腹腔镜手术的成本。在访问其他特殊设备的国家中可能会考虑使用它。

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