摘要
背景：食管切除术后进行的食管胃吻合技术复杂，往往是术后并发症的根源。这种吻合术的最佳技术仍然存在争议。我们描述了一种新的全吻合侧对侧吻合术，我们称之为三钉四边吻合术（TRIQ），可以在微创手术后进行，我们报告了对术后结果的回顾性评估结果。迄今已进行过吻合术的60名患者。
方法：吻合术是通过食管和胃的后壁并置而产生的。应用线性吻合器以形成V形后部吻合壁。使用2个独立的线性吻合器，前壁以柔和的人字形状闭合，导致宽的四边形吻合。然后用更大的网膜皮瓣包裹吻合口。
结果：患者组包括48名男性和12名女性，平均年龄为67.8岁。其中43例患者进行了新辅助化疗。在任何患者中，胸腔镜或腹腔镜手术均未转为开放手术。中位手术时间为474分钟（范围680-320分钟）。术中出血量为104.4 mL（范围240-30 mL）。 Clavien-Dindo II级以上没有与吻合相关的并发症。
结论：TRIQ可以轻松安全地进行，并且可以预期良好的短期结果。
Esophagus. 2018 Apr;15(2):88-94. doi: 10.1007/s10388-017-0599-z. Epub 2017 Dec 16.
Triple-stapled quadrilateral anastomosis: a new technique for creation of an esophagogastric anastomosis.
- 1
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan. yj-ishibashi@juntendo.ac.jp.
- 2
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
- 3
- Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kanagawa, Japan.
Abstract
BACKGROUND:
Esophagogastric anastomosis performed after esophagectomy is technically complex and often the source of postoperative complications. The best technique for this anastomosis remains a matter of debate. We describe a new all-stapled side-to-side anastomosis, which we refer to as triple-stapled quadrilateral anastomosis (TRIQ), that can be performed after minimally invasive surgery, and we report results of a retrospective evaluation of postoperative outcomes among the 60 patients in whom this anastomosis has been performed thus far.
METHODS:
The anastomosis is created by apposition of the posterior walls of the esophagus and stomach. A linear stapler is applied to create a V-shaped posterior anastomotic wall. The anterior wall is closed in a gentle chevron-like shape with the use of 2 separate linear staplers, resulting in a wide quadrilateral anastomosis. The anastomosis is then wrapped with a greater omentum flap.
RESULTS:
The patient group comprised 48 men and 12 women with a mean age of 67.8 years. Neoadjuvant chemotherapy was performed in 43 of these patients. Neither the thoracoscopic or laparoscopic procedure was converted to open surgery in any patient. The median operation time was 474 min (range 680-320 min). The intraoperative blood loss volume was 104.4 mL (range 240-30 mL). There were no anastomosis-related complications above Clavien-Dindo grade II.
CONCLUSIONS:
TRIQ can be performed easily and safely, and good short-term outcome can be expected.
KEYWORDS:
Anastomotic leakage; Esophageal cancer; Esophagogastric anastomosis; Linear stapled anastomosis