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胃节段切除术后不同吻合方式对胃功能的影响

Influence of different anastomotic methods on gastric function

摘要:

胃节段切除术是目前较为常见的功能保留性胃切除术之一,其联合前哨淋巴结导航技术在早期胃癌的治疗中展现出广阔的应用前景。胃节段切除术后常见的吻合方式包括:(1)手工吻合:该操作相对简便,减少了吻合器的使用,可有效降低手术成本,常需开腹或小切口辅助完成吻合。(2)Delta吻合:该吻合为全腔镜下吻合,手术创伤小,但由于侧-侧吻合小弯侧存在残腔,且有可能过度切割胃后壁而缩短幽门袖,增加术后胃潴留的风险;(3)杂交法吻合:该吻合方式安全有效,但需行全腔镜下缝合胃前壁,对术者技术要求较高,建议由腹腔镜胃肠手术经验丰富的ManBetX万博官网地址下载 开展;(4)穿刺法吻合:该吻合方式为端-端吻合,胃潴留风险低,且适用于全腔镜下吻合,但使用的吻合器比较特殊,给临床推广带来了一定的限制。这几种吻合方式各有利弊,对胃功能的影响亦存在争议。总而言之,胃节段切除术的发展尚处于初级阶段,肿瘤学安全性的确认、技术的标准化等,仍需前瞻性多中心的随机对照研究来提供理论与技术支持。

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abstracts:

Segmental gastrectomy is a common function preserving operation, and its combination with sentinel lymph node navigation technology shows a broad prospect in the treatment of early gastric cancer. Commonly anastomosis methods include the follows: (1) Hand-sewn anastomosis: this method is relatively simple, reduces the use of stapler, and can effectively reduce surgical cost. However, laparotomy or small-incision assisted laparoscopic surgery is required to accomplish anastomosis, so the surgical wound is relatively large. (2) Delta anastomosis: this anastomosis is entirely endoscopic, requiring no small incision with less surgical trauma. However, due to the presence of residual cavities in the small curvature of the side-to-side anastomosis, and the possibility of excessive incision of the posterior wall of the stomach, which may shorten the pyloric sleeve, there is an increased risk of gastric stasis after the operation. (3) Hybrid technique: this anastomosis method is safe and effective. However, it requires total endoscopic gastric anterior wall suture, which represents higher requirements for surgeons. Therefore, surgeons experienced in minimally invasive surgeries are recommended to perform this anastomosis. (4) Puncture technique: this anastomotic method is end-to-end anastomosis with low risk of gastric stasis, and is applicable for entirely endoscopic anastomosis. However, the stapler is not typically used for gastrointestinal surgery, which brings certain limitations to clinical promotion. These anastomoses have their own advantages and disadvantages, and their effects on gastric function are also controversial. In conclusion, the development of segmental gastrectomy is still in its infancy, and prospective multicenter randomized controlled trials are awaited to confirm the safety of oncology and standardize the techniques.

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作者: 谢博文 [1] 臧潞 [1]
期刊: 《中华胃肠外科杂志》2020年23卷10期 927-930页 MEDLINEISTICPKUCSCD
栏目名称: 专题论坛
DOI: 10.3760/cma.j.cn.441530-20200721-00434
发布时间: 2024-07-30
基金项目:
上海市卫生健康委先进适宜技术推广项目 Shanghai Municipal Health Commission Advanced Appropriate Technology Promotion Project
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