摘要
完全腹腔镜全胃切除术(TLTG)具有一定的技术难度,而更多的挑战体现在消化道重建环节。线型吻合器的使用,在一定程度上降低了消化道重建的难度,并有力推动了全胃切除术由腹腔镜辅助向完全腹腔镜的过渡。但在实施完全腹腔镜全胃切除术中,应用线型吻合器完成消化道重建仍有许多细节需要关注。笔者通过分享自身经验和教训并结合相关文献,对TLTG中应用线型吻合器完成消化道重建的诸多技术细节进行了剖析,包括与术野显露相关的技术细节、应用线型吻合器行食管空肠吻合术发生特有意外事件相关的技术细节、与腹内疝及Roux淤滞综合征相关的操作细节以及食管或空肠残端钉合线(缝钉)的处理细节等,为有效规避陷阱、确保手术的流畅与安全提供了切合实际、行之有效的临床参考。
With the development of instrument,equipment and surgical skills,especially the emergence of a series of high-level medical evidence,the laparoscopic techniques in the field of gastric surgery has been further expanded.Totally laparoscopic total gastrectomy(TLTG)has certain technical difficulties,and more challenges are reflected in the digestive tract reconstruction.The use of linear staplers has reduced the difficulty of digestive tract reconstruction to a certain extent and has strongly promoted the transition from laparoscopic-assisted total gastrectomy to TLTG.However,for TLTG,there are still many details that should be carefully concerned,so as to effectively avoid the surgical pitfalls and ensure the fluency and safety of the procedure.In this article,we discuss the surgical details based on our own experiences,including how to obtain surgical field exposure well,how to manage specific accidents when using linear stapler for esophagojejunostomy,how to prevent intra-abdominal hernias and Roux stasis syndrome,and how to prevent the stapled lines of the esophageal or jejunal stumps from direct contact with aorta.
作者
何显力
高鹏
王楠
He Xianli;Gao Peng;Wang Nan(Department of General Surgery,The Second Affiliated Hospital,Air Force Medical University,Xi'an 710038,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2022年第5期378-384,共7页
Chinese Journal of Gastrointestinal Surgery
基金
陕西省重点产业创新链(群)-社会发展领域(2022ZDLSF04-05)
空军军医大学第二附属医院学科提升项目(2020XKPT010)。
