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目的 介绍管状吻合器和生物吻合环在胃癌全胃切除术中消化道重建中的应用体会。方法 全胃切除术中用Roux -Y方式重建消化道 ,其中食管空肠吻合由吻合器完成 ,而空肠间端侧吻合由手工缝合或用可降解吻合环完成。结果 本组 5 6例食管空肠对端吻合及空肠端侧吻合均获一次性成功 ,无手术死亡 ,无吻合口漏。手术时间 90～ 3 10min ,平均 160min。用吻合环完成空肠端侧吻合者平均手术时间仅为 13 0min。术后 6～ 12个月随诊胃镜或钡餐检查 ,5 4例吻合口愈合良好 ,仅 2例出现吻合口狭窄 ,并通过气囊扩张后症状明显改善。结论 在全胃切除术消化道重建中 ,应用吻合器和吻合环作吻合有方便、快捷、可靠等优点 ,有利于防止吻合口漏等并发症。只要患者经济条件允许 ,尽量采用一次性吻合器和吻合环重建消化道。
Objective To introduce the application of tubular stapler and biological anastomosis ring in the reconstruction of gastrointestinal tract during total gastrectomy for gastric cancer. Methods Total gastrectomy Roux-Y reconstruction of the digestive tract, esophageal jejunal anastomosis by the stapler, and jejunostomy end-side anastomosis by hand or with a biodegradable stapling ring to complete. Results The group of 56 cases of esophageal jejunal end to end anastomosis and jejunal end to end anastomosis were a one-time success, no operative death, no anastomotic leakage. Surgery time 90 ~ 3 10min, an average of 160min. With anastomosis ring to complete the end of jejunum anastomosis, the average operation time is only 13 0min. Follow-up gastroscope or barium meal examination was performed 6 to 12 months after operation, 54 anastomotic sites healed well, and only 2 cases showed anastomotic stenosis, and the symptoms after balloon expansion were significantly improved. Conclusion In total gastrectomy digestive tract reconstruction, the use of anastomosis and anastomosis for anastomosis convenient, fast, reliable, etc., is conducive to preventing complications such as anastomotic leakage. As long as the patient’s economic conditions permit, try to use disposable stapler and anastomosis ring reconstruction of the digestive tract.