[1]魏秋亚 李姗姗① 李晓军 朱占弟 王琛 樊勇**.钉砧系统在肥胖患者腹腔镜全胃切除术后消化道重建中的应用[J].中国微创外科杂志,2020,01(1):10-18.
　Wei Qiuya*,Li Shanshan,Li Xiaojun*,et al.Application of OrVil System in Digestive Tract Reconstruction After Laparoscopic Total Gastrectomy for Gastric Cancer in Obese Patients[J].Chinese Journal of Minimally Invasive Surgery,2020,01(1):10-18.
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钉砧系统在肥胖患者腹腔镜全胃切除术后消化道重建中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年1期
页码:
10-18
栏目:
临床研究
出版日期:
2020-03-25

文章信息/Info

Title:
Application of OrVil System in Digestive Tract Reconstruction After Laparoscopic Total Gastrectomy for Gastric Cancer in Obese Patients
作者:
魏秋亚 李姗姗① 李晓军 朱占弟 王琛 樊勇**
（兰州大学第二医院普外科，兰州730000）
Author(s):
Wei Qiuya*;  Li Shanshan;  Li Xiaojun*;  et al.
*Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730000, China
关键词:
钉砧系统; 腹腔镜全胃切除术; 肥胖
Keywords:
OrVil system; Laparoscopic total gastrectomy; Obesity
文献标志码:
A
摘要:
目的探讨腹腔镜全胃切除术后消化道重建采用钉砧头系统（OrVil）在腔内行食管空肠RouxenY吻合的临床应用价值。方法回顾性分析我科2015年1月~2018年1月采用腹腔镜全胃根治术+D2淋巴结清扫+OrVil腔内行食管空肠RouxenY吻合消化道重建治疗28例Siwert Ⅱ、Ⅲ型肥胖胃癌作为实验组，筛选同期年龄、性别、体重指数、ASA分级、病理分期、TNM分期、合并症及肿瘤位置等与实验组组患者无明显差异的28例肥胖胃癌作为对照组，并行腹腔镜全胃根治术+D2淋巴结清扫+开腹辅助食管空肠RouxenY吻合。比较2组患者的术中、术后情况。结果实验组消化道重建时间（48.6±6.9）min，明显短于对照组（55.7±5.6）min（t=4.193，P=0.000）；食管空肠吻合时间（12.5±2.5）min，明显短于对照组（20.4±3.3）min（t=10.055，P=0.000）；切口长度（5.2±1.0）cm，明显短于对照组（10.7±2.1）cm（t=12.469，P=0.000）；术后镇痛时间（2.6±0.5）d，明显短于对照组 （3.2±0.8）d（t=2.903，P=0.005）；肛门排气时间（3.2±0.5）d，明显少于对照组（3.8±0.8）d（t=3.635，P=0.001）；进流质饮食时间（3.2±0.6）d，明显少于对照组（4.0±0.6）d（t=4.688，P=0.000）；术后住院时间（7.8±1.2）d，明显短于对照组（9.0±1.4）（t=-3.629，P=0.001）。2组术中冰冻切缘阳性率（3.6% vs. 107%）（χ2=0.269，P=0.604）和淋巴结清扫数目［（27.0±6.3）枚 vs.（27.5±6.3）枚，t=-0.277，P=0.783］无统计学差异。2组并发症发生率差异无显著性（P＞0.05）。结论腹腔镜全胃切除术后消化道重建采用OrVil在腔内进行食管空肠吻合操作，可缩短吻合时间，腹部切口小、疼痛时间短促进患者胃肠道功能较早的恢复，加快患者康复的过程。
Abstract:
ObjectiveTo evaluate the clinical application of the OrVil system in intraluminal RouxenY esophagojejunostomy for digestive tract reconstruction after laparoscopic total gastrectomy. MethodsFrom January 2015 to January 2018, 28 obese cases of Siwert type Ⅱ or Ⅲ gastric cancer (experimental group) were treated by laparoscopic total gastrectomy and D2 lymph node dissection and digestive tract reconstruction with the OrVil system intraluminal RouxenY anastomosis in our department. Another 28 cases, without significantly different age, gender, body mass index, ASA classification, pathological stage, TNM stage, comorbidities and tumor location were regarded as the control group. Laparoscopic total gastrectomy and D2 lymph node dissection and laparotomy assisted RouxenY esophagojejunostomy were performed. The intraoperative and postoperative conditions of the two groups were compared.ResultsThe time of digestive tract reconstruction in the experimental group was significantly shorter than that in the control group ［(48.6±6.9) min vs. (55.7±5.6) min, t=4.193, P=0.000］; the time of esophagojejunostomy was significantly shorter than that in the control group ［(12.5±2.5) min vs. (20.4±3.3) min, t=10.055, P=0.000］; the length of incision was significantly less than that in the control group ［(5.2±1.0) cm vs. (10.7±2.0) cm, t=12.469, P=0.000］; the time of postoperative analgesia was significantly shorter than that in the control group ［(2.6±0.5) d vs. (3.2±0.8) d, t=2.903, P=0005］; the time of anal exhaust was significantly less than that of control group ［(3.2±0.5) d vs. (3.8±0.8) d, t=3.635, P=0.001］; the time to liquid diet intake was significantly less than that of control group ［(3.2±0.6) d vs. (4.0±0.6) d, t=4.688, P=0.000］; the hospital stay after operation was significantly less than that of the control group ［(7.8±1.2) d vs. (9.0±1.4), t=-3.629, P=0.001］. There were no statistical differences in the positive rate of frozen margin during operation (3.6% vs. 107%, χ2=0.269, P=0.604) and the number of lymph node dissection ［(27.0±6.3) vs. (27.5±6.3), t=0.277, P=0783］. There was no significant difference in the incidence of complications between the two groups (P>0.05).ConclusionsAfter laparoscopic total gastrectomy, gastrointestinal reconstruction with OrVil system can shorten the time of anastomosis. In addition, small abdominal incision and short pain time can accelerate the process of getting out of bed, thus promoting the early recovery of gastrointestinal function.

参考文献/References:

[1]苏向前,姚震旦.全腹腔镜全胃切除术食管空肠器械吻合技术难点及对策.中国实用外科杂志,2016,36(9):945-948.
[2]Wang FG, Yu ZP, Yan WM, et al. Comparison of safety and effectiveness between laparoscopic minigastric bypass and laparoscopic sleeve gastrectomy: A metaanalysis and systematic review. Medicine,2017,96(50):e8924.
[3]赵永亮,余佩武.腹腔镜全胃切除术后消化道重建方式的探讨.第三军医大学学报,2013,35(18):1907-1909.
[4]中华医学会健康管理学分会，中国营养学会，中国医疗保健国际交流促进会生殖医学分会，等.超重或肥胖人群体重管理专家共识及团体标准.中华健康管理学杂志,2018,12(3):200-207.
[5]Kitano S, Iso Y, Moriyama M, et al. Laparoscopyassisted Billroth I gastrictomy. Surg Laparosc Endosc,1994,4(2):146.
[6]Wang H, Hao Q, Wang M, et al. Esophagojejunostomy after laparoscopic total gastrectomyby OrVilTM or hemidouble stapling technique. World J Gastroenterol,2015,21(29):8943-8951.
[7]Lee MS, Lee JH, Park DJ, et al. Comparison of short and longterm outcomes of laparoscopicassisted total gastrectomy and open total gastrectomy in gastric cancer patients. Surg Endosc, 2013, 27(7):2598-2605.
[8]黄昌明,陈建新,郑朝辉,等.肥胖胃癌病人行腹腔镜与开腹根治术手术临床疗效对比分析.中国实用外科杂志,2011,31(8):681-683.
[9]Shimada S, Sawada N, Ishiyama Y, et al. Impact of obesity on short and longterm outcomes of laparoscopy assisted distal gastrectomy for gastric cancer. Surg Endosc,2017,32(1):1-9.
[10]胡军红,杨德生,王晨宇,等.腹腔镜辅助胃癌根治术在老年肥胖患者的应用.中国普通外科杂志,2013,22(10):1261-1265.
[11]刘世强,区小卫,张少锐,等.左上腹切口与正中切口应用OrVil吻合器行腹腔镜食管空肠吻合术的比较.中国微创外科杂志,2013,13(8):685-688.
[10]所剑, 李伟, 张洋.全腹腔镜胃癌根治术常见并发症及中转开腹原因.中国实用外科杂志,2016,36(9):948-952.
[11]Hiyoshi Y, Oki E, Ando K, et al. Outcome of esophagojejunostomy during totally laparoscopic total gastrectomy: a singlecenter retrospective study. Anticancer Res,2014,34(12):7227-7232.
[12]Li X, Hong L, Ding D, et al. Comparison of OrVilTM and RPD in laparoscopic total gastrectomy for gastric cancer. Surg Endosc,2017,31(11):1-7.

备注/Memo

备注/Memo:
基金项目：2017年度甘肃省卫生行业项目（GSWSKY2017-36）**通讯作者，Email：fanyong1972@163.com①重症医学科
更新日期/Last Update: 2020-04-16