1、全腹腔镜下胃癌根治术消化道重建 学习实践 广东省人民医院广东省人民医院/广东省医学科学院广东省医学科学院 胃肠外科胃肠外科/胃肠肿瘤外科胃肠肿瘤外科 李勇李勇 History of reconstruction methods Variations of B-I, B-II ,RY procedures Hyung-Ho Kim 腹腔镜下远端胃切除消化道重建 Billroth I 式：三角吻合 Billroth II 胃空肠吻合：顺蠕动，逆蠕动 胃空肠Roux-en-Y吻合 Billroth II 胃空肠吻合：顺蠕动 Billroth II 胃空肠吻合：顺蠕动 Billroth II 胃空肠吻
2、合：顺蠕动 Billroth II 胃空肠吻合：顺蠕动 Billroth II 胃空肠吻合：顺蠕动 Billroth II 胃空肠吻合：顺蠕动 Billroth II 胃空肠吻合：顺蠕动 Billroth II 胃空肠吻合：顺蠕动 Billroth II 胃空肠吻合：顺蠕动 Billroth II 胃空肠吻合：逆蠕动 Billroth II 胃空肠吻合：逆蠕动 Billroth II 胃空肠吻合：逆蠕动 Billroth II 胃空肠吻合：逆蠕动 Billroth II 胃空肠吻合：逆蠕动 2020/5/10 2020/5/10 胃空肠Roux-en-Y吻合 胃空肠Roux-en-Y吻合 胃空
3、肠Roux-en-Y吻合 胃空肠Roux-en-Y吻合 胃空肠Roux-en-Y吻合 胃空肠Roux-en-Y吻合 全器械全器械 吻合吻合 胃空肠Roux-en-Y吻合 胃空肠Roux-en-Y吻合 Application of Uncut Roux- en-Y gastrojejunostomy in TLG Guangdong General Hospital Guangdong Academy of Medical Science Gastrointestinal surgery Yong Li, Deqing Wu, Xingyu Feng History of Uncut Roux-
4、en- Y(URY) Stiegmann and Goff reported this technique for treatment of bile reflux gastritis in 1988 Morrison et al. and Miedema reported that this method preserved gastric emptying and prevented the Roux stasis syndrome. Surg Gynecol Obstet 1988;166:69 70. Am J Surg 1990;160:2526 Arch Surg 1992;127
5、:295300 Methods of URY I I I I I I Application of URY in LADG Uyama et al. “Application of URY in Laparoscopy-assisted distal gastrectomy “ in Gastric Cancer (2005) 8: 253257 Uyama et al. 2005 42 patients underwent the URY reconstruction. The reconstruction took a mean time of 46 mins. Postoperative
6、 gastric stasis 6 of the 54 patients(11%) in the conventional Roux operation group 2 of the 42 patients (4.8%) in the uncut Roux operation group P 0.05 Application of URY in TLG NK45 Our experience of URY in TLG Our experience of URY in TLG R G A LGA GC V Our experience of URY in TLG 2 1 3 3 1 2 5 4
7、 6 6 5 4 Our experience of URY in TLG Our experience of URY in TLG VEDIO Our experience of URY in TLG 丌同阻断输入袢的方法 Our experience of URY in TLG 丌同阻断方法术后输入袢蠕动 的比较 Our experience of URY in TLG Methods 30 patients who underwent TLG in 6 hospital of China between February 2014 and January 2015 were enroll
8、ed in this study. operation method: distal gastrectomy+D2 lymphadenectomy+ Uncut Roux-en-Y reconstruction (TLG) Male 19,Female 11 Mean age ：56.1 Results number of resection LN : 36.99.0 Length of incision :4.81.18cm Operaton time:223.547.2min Reconstruction time:52.810.9min Estimated blood loss:5330
9、.7ml Open conversion(person): 0 retain time of gastric tuber： 2.51.2 days retain time of catheter:1.91 days First flatus:2.90.9 days Liquid diet:2.91.2 days Complication (person): 2 The block site of reopen(person):2 Motality (person): 0 Conclusion Uncut Roux-en-Y gastrojejunostomy in TLG is safe an
10、d feasible. shorter operating time and anastomotic time, less bleeding, faster patient recovery. The advantage of preventing the Roux stasis syndrome need more follow-up information. The block site of jejunum may reopen in some patients. Our clinical trail VS CONCLUSION 1、伦理性：URY源于传统的手术毕II式吻合加布朗 斯吻合
11、以及ROUX-EN-Y手术的技巧 2、可行性：URY在腹腔镜技术上讲的可行的 3、安全性：我们没有观察到手术的患者出现了吻 合口漏、腹腔出血和吻合口狭窄的情况 4、我们需要更多的病例和随访的数据 Acknowledgements Rui Jin Hospital Shang Hai Jiao Tong University School Of Medicine Fu Jian Provincial Cancer Hospital (FPCH) Jiang Su Province Hospital (The First Afflicated Hospital of Nan Jing Medica
12、l School) The Second Hospital Bethune Of Ji Lin University Bei Jing Cancer Hospital 全腔镜下全胃切除胃癌D2根治食管空肠吻合术 Orvil辅助管型吻合器食管空肠端侧吻合法 反穿刺技或手工荷包管型吻合器食管空肠端侧吻合法 食管空肠直线切割器侧侧吻合（FEE法） 倒T型食管空肠直线切割器侧侧吻合法（T shape） 食管空肠直线切割器侧侧交叠吻合法（Over-Lap） 改良型食管空肠直线切割器侧侧交叠吻合法 Orvil辅助食管空肠端侧吻合 反穿刺技术食管空肠端侧吻合 食管空肠侧侧吻合(FEE) 食管空肠侧侧吻合(F
13、EE) 倒T型食管空肠侧侧吻合法(T SHAPE) Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy :Inverted T-shaped anastomosis using linear staplers. Eishi Nagai,et. Kyushu,Japan. 倒T型食管空肠侧侧吻合法(T SHAPE) 食管空肠侧侧交叠吻合法(Over-Lap) 改良型食管空肠侧侧交叠吻合法 改良型食管空肠侧侧交叠吻合法 改良型食管空肠侧侧交叠吻合法 THANKS FOR YOUR ATTENTION
