论文部分内容阅读
全腹腔镜远端胃癌根治术消化道重建方式主要为BillrothⅠ式三角吻合、BillrothⅡ式吻合和胃空肠Roux-enY吻合。BillrothⅠ式三角吻合的应用须严格把握适应证,而胃空肠Roux-en-Y吻合近年来有增多趋势,BillrothⅡ式+Braun吻合和非离断式Roux-en-Y吻合较Roux-en-Y吻合更简单易行,在全腹腔镜下操作时更易于掌握。全腹腔镜全胃切除术消化道重建可分为腔内直线切割闭合器吻合与圆形吻合器吻合两种方式,当前对各类应用直线切割闭合器进行重建的关注多于圆形吻合器。随着直线切割闭合器在全腹腔镜下的应用逐渐成熟,其各种优势开始逐渐显现,并且是真正意义上的全腹腔镜吻合方式。由于全腹腔镜下重建较小切口辅助手术视野更好,操作空间更大,吻合过程均在腹腔镜监视下完成,而且随着腹腔镜下切割吻合器械的研发与改进,其吻合更安全可靠,且并发症的发生率亦逐渐降低。
Total laparoscopic radical gastrectomy of the digestive tract reconstruction of the main methods for the Billroth Ⅰ triangular anastomosis, Billroth Ⅱ anastomosis and Roux-enY gastrojejunostomy. Billroth Ⅰ triangular anastomosis should be strictly applied indications, and the gastrointestinal Roux-en-Y anastomosis in recent years there is an increasing trend, Billroth Ⅱ + Braun anastomosis and non-interrupted Roux-en-Y anastomosis Roux-en-Y anastomosis Easier to operate, easier to grasp during full laparoscopic operation. Total laparoscopic total gastrectomy digestive tract reconstruction can be divided into intraluminal linear closure of the stapler and circular stapling anastomosis in two ways, the current application of various types of linear incision closure device reconstruction more attention than circular stapler. With the application of linear incision closure in full laparoscopic gradually mature, its advantages began to gradually appear, and is the true sense of the whole laparoscopic anastomosis. As the whole laparoscopic reconstruction of smaller incision assisted surgery better field of vision, larger operating space, the anastomosis process are completed under laparoscopic surveillance, and with laparoscopic cutting anastomotic device development and improvement, the anastomosis more secure, And the incidence of complications also gradually decreased.