经口抵钉座置入系统在胃癌腹腔镜全胃切除术消化道重建中的临床价值

目的 探讨应用经口抵钉座置入系统( OrVilTM)在胃癌腹腔镜全胃切除术消化道重建中的临床价值.方法 回顾性分析2011年1月至2012年2月南方医科大学南方医院收治的8例晚期胃癌患者的临床资料.患者先在腹腔镜下完成全胃切除+ D2淋巴结清扫术,辅助切口取出全胃标本后,应用OrVilTM完成食管空肠吻合.分析患者术中、术后和预后情况.结果 所有患者顺利完成腹腔镜全胃切除+小切口辅助Roux-en-Y食管空肠吻合术,无术中并发症发生,在吻合时无需延长辅助切口.平均手术时间为(203±38)min,平均抵钉座放置时间为(10±4) min,术中平均出血量为(106±18)ml.术后病理检查证实切缘均为阴性.术后平均肛门排气时间、平均恢复流质饮食时间、平均恢复半流质饮食时间、平均住院时间分别为(3.5±1.3)d、(5.5±2.9)d、(7.5±3.2)d、(11.5±3.5)d.8例患者中位随访时间为10个月(1 ～14个月),无术后近、远期吻合口相关并发症(瘘、狭窄、出血)发生.结论 OrVilTM在胃癌腹腔镜全胃切除+小切口辅助Roux-en-Y食管空肠吻合术中的应用安全可行.     

全腹腔镜全胃癌根治术食管右侧近端空肠Roux-en-Y吻合消化道重建的临床应用

目的探讨全腹腔镜全胃癌根治术食管右侧近端空肠Roux-en-Y吻合进行消化道重建手术方式的临床应用。方法中上部胃癌患者15例,均行全腹腔镜下全胃癌根治术食管右侧近端空肠Roux-en-Y吻合术,观察患者术后排气时间、术后住院时间、淋巴结清扫数目和手术后相关早期并发症等。结果 15例患者均完成全腹腔镜下全胃癌根治术食管右侧近端空肠Rouxen-Y吻合,手术时间(272±22.5)分钟,消化道重建时间(47.0±14.6)分钟,出血量(63.0±20.4)ml。患者术后排气时间(2.9±0.6)天,术后住院时间(9.1±1.5)天,淋巴结清扫数目(27.6±6.3)枚,无手术相关早期并发症。结论全腹腔镜下采用全胃癌根治术后食管右侧近端空肠Roux-enY吻合的消化道重建方式安全,操作简便,术后恢复快,符合肿瘤手术无瘤原则。     

θ��ȫθ�г����������������ؽ���ʽ�ıȽϹ۲�

目的：探讨全胃切除术后合理的消化道重建方式。方法 自1996年5月至2001年5月，对106例全胃切除术采用了三种不同的术式，对其手术时间、手术并发症、术后1年饮食状况、消化道症状及营养指标进行对比观察。结果：Orr式空肠食管Roux-en-Y吻合术和P式空肠食管Roux-en-Y吻合术，术后能有效地防止反流性食管炎，明显优于Moynihan式吻合术。Orr式空肠食管Roux-en-Y吻合术和P式空肠食管Roux-en-Y吻合术相比，操作更简单，手术时间短，手术并发症也较少。结论：Orr式空肠食管Roux-en-Y吻合术是胃癌全胃切除后消化道重建较为合适的术式。     

胃癌术后食管空肠Roux-en-Y吻合与间置空肠代胃远期效果及对营养状况和生活质量的影响

目的探讨胃癌术后食管空肠Roux-en-Y吻合与间置空肠代胃远期效果及对营养状况和生活质量影响。方法行胃癌根治手术病人65例,根据治疗方法的不同分为两组,JIP组29例,行近端胃大部分切除+间置空肠代胃,Roux-en-Y吻合组36例,行全胃切除+食管空肠Roux-en-Y吻合。比较两组病人手术时间、住院时间、远期并发症、术后营养状况以及生活质量。结果 JIP组和Roux-en-Y组手术时间分别为(124.36±13.47)分钟和(122.09±14.28)分钟,住院时间分别为(14.98±3.65)天和(15.38±3.72)天,术后6个月反流性食管炎发生率分别为17.24%(5/29)和16.67%(6/36),腹泻发生率分别为6.90%(2/29)和8.33%(3/36),两组比较差异无统计学意义(P0.05);JIP组倾倒综合征发生率为10.34%(3/29)和RSS综合征发生率为13.79%(4/29),Roux-en-Y组分别为44.44%(16/36)和30.56%(11/36),两组比较差异有统计学意义(P0.05);JIP组和Roux-en-Y组术后血红蛋白增加分别为(18.56±3.08)g/L和(12.42±2.16)g/L,白蛋白增加分别为(13.74±2.36)g/L和(8.01±2.17)g/L,体重增加分别为(4.69±2.87)kg和(2.27±1.35)kg,预后营养指数增加分别为(15.33±4.07)和(5.87±1.82),两组间比较差异有统计学意义(P0.05);JIP组和Roux-en-Y组术后总生活质量评分分别为(87.69±11.12)和(73.62±10.77)(P0.05)。结论与全胃切除+食管空肠Roux-en-Y吻合术比较,近端胃大部分切除+间置空肠代胃术可降低病人术后远期并发症的发生,改善病人术后的营养状况和生活质量。     

腹腔镜全胃切除术后食管空肠半端端吻合21例

目的探讨腹腔镜全胃切除术后消化道重建的新方法及其效果。方法对21例胃癌行腹腔镜全胃切除术后患者,采用食管空肠半端端吻合的方法进行Roux-en-Y消化道重建。结果全组患者均成功完成腹腔镜全胃切除、食管空肠半端端吻合术。手术时间（25±37）min,其中吻合时间为（51±19）min。术中平均出血量为（89±48）ml。术后住院天数（8±3）d。术后近期恢复良好。无并发症出现。结论腹腔镜全胃切除术后食管空肠半端端吻合方法安全可行,操作简单,吻合时间短．并可有效避免吻合口狭窄等并发症的发生。     

两种消化道重建手术在胃癌根治术后恢复中的应用效果及其对生活质量的影响

目的分析根治性近端胃切除空肠间置吻合术与根治性全胃切除食管空肠Rouxen-Y吻合术对胃癌病人术后恢复及生活质量的影响。方法近端胃癌病人50例,按数字表法将50例病人随机分为对照组和观察组,每组25例。对照组病人实施根治性全胃切除食管空肠Rouxen-Y吻合术,观察组病人实施根治性近端胃切除空肠间置吻合术。比较两组病人手术前后血常规、肝肾功能、术后并发症发生情况、术后胃食管反流情况以及手术前后生活质量。结果两组病人术前、术后血常规和肝肾功能各项指标无明显变化,差异无统计学意义(P0.05)。观察组术后出现反流性食管炎明显少于对照组,钡剂反流入食管例数明显少于对照组,差异有统计学意义(P0.05)。两组病人术后躯体功能、情绪功能、整体健康生活质量评分和术前比较明显较高,观察组病人术后情绪功能、整体健康生活质量评分和对照组比较明显较高,差异有统计学意义(P0.05)。结论近端胃切除空肠间置吻合术能明显减少胃癌病人术后反流性食管炎的发生率,提高病人生活质量,临床效果优于根治性全胃切除食管空肠Roux-en-Y吻合术。     

腹腔镜进展期胃癌D_2根治术手术路径的探讨

目的:探讨腹腔镜胃癌D2根治术的手术路径选择。方法:回顾分析为42例患者行腹腔镜胃癌D2根治术的临床资料。结果:42例手术均获成功,无一例中转开腹;其中18例行远端胃大部切除胃空肠Roux-en-Y吻合术,16例行全腹腔镜下远端胃大部切除胃十二指肠毕Ⅰ吻合术,8例行根治性全胃切除食管空肠Roux-en-Y吻合术。手术时间160～310 min,平均(218±34)min;术中出血量30～280 ml,平均(70±42)ml;清扫淋巴结数量16～32枚,平均(26±8)枚;术后分期Ⅰb期7例,Ⅱ期27例,Ⅲa期8例。结论:术者合理站位并选择合理正确的技术路线使腹腔镜胃癌D2根治术操作简便、易行。     

食管空肠重叠法三角吻合用于胃癌腹腔镜下全胃和近端胃切除的临床疗效

目的: 探讨食管空肠重叠法三角吻合在胃癌腹腔镜全胃和近端胃切除术中临床应用的可行性和安全性。方法: 回顾性分析2017年10月至2018年3月间9例胃癌病人腹腔镜胃切除的临床资料。4例近端胃癌病人行腹腔镜近端胃切除和双通道重建。1例近端胃癌和4例胃体癌病人行腹腔镜全胃切除和Roux-en-Y吻合。9例均采用食管空肠重叠法三角吻合（改良重叠法）。结果: 本研究病人食管空肠重叠法三角吻合均成功完成。总手术时间为（273.9±48.2） min。食管空肠重叠法三角吻合时间为（40.9±13.3） min。术中出血量为（58.9±43.4） mL,淋巴结清扫数为（27.1±11.8）枚。上、下切缘病理检查结果均未见癌残留。术后首次肛门排气时间为（2.5±0.9） d,进流质时间为（4.8±1.3） d,术后住院时间为（7.9±1.8） d。病人均无术后并发症发生。结论: 食管空肠重叠法三角吻合在胃癌腹腔镜全胃和近端胃切除术中的临床应用,可行且安全。     

两种不同消化道重建方式在近端胃癌切除术中的应用

本研究对根治性近端胃大部切除术后患者使用食管残胃间空肠间置术进行消化道重建,并与近端胃癌全胃切除Roux-en-Y吻合术进行比较,观察两组患者手术时间、手术并发症、术后生活质量及营养状况的变化. 资料与方法 1.一般资料:选择河南省肿瘤医院普外科2010年10月至2012年4月行根治性近侧胃大部切除食管残胃间空肠间置(观察组)32例、全胃切除食管空肠Roux-en-Y吻合(对照组)30例的胃癌患者,其中男46例,女16例;年龄(58±10)岁.术后病理检查结果:观察组:Ⅰa期5例,Ⅰb期9例,Ⅱ期12例,Ⅲa期6例;对照组:Ⅰb期3例,Ⅱ期5例,Ⅲa期10例,Ⅲb期12例.     

全胃切除术后三种消化道重建术式的比较研究

目的 探讨全胃切除术后合理的消化道重建方式。方法对189例胃癌患者全胃切除术后分别采用了Orr式Roux-en-Y空肠食管吻合术、P形空肠袢空肠食管Roux-en-Y吻合术和Moynihan式吻合术进行消化道重建，对其手术时间、手术并发症、术后1、3年饮食状况和消化道症状及营养指标进行对比观察。结果3种术式的患者手术死亡率、术后1年和3年的饮食状况、腹泻和倾倒综合征的发生率比较，均P〉0．05；差异无统计学意义。术后1、3、5年的累计生存率比较，P〉0．05，差异也元统计学意义。Orr式空肠食管Roux-en-Y吻合术和P形空肠袢空肠食管Roux-en-Y吻合术后均能有效地防止反流性食管炎，明显优于Moynihan式吻合术（P〈0．01）。Orr式空肠食管Roux-en-Y吻合术较P形空肠袢空肠食管Roux-en-Y吻合术操作简单、手术时间短、手术并发症也较少。结论Orr式空肠食管Roux-en-Y吻合术是胃癌全胃切除后消化道重建较为合适的术式。     

��ǻ����������������������ؽ������ǺϷ�ʽ

快速康复外科(fasttrack surgery)通过优化围手术期的处理加速了病人的康复速度,它是继腹腔镜外科以后的又一次外科革命。由于传统腹腔镜外科的器械及二维视野的局限,在腹腔镜下进行全胃切除后食管空肠吻合仍存在不少的困难。而机器人手术提供三维放大视野、7个自由度的器械等优势,有利于在狭小的空间内精准完成食管空肠吻合术。全机器人下吻合有利于切口的微小化以及减少术后并发症的发生,这将可能成为上消化道重建的标准手术方法之一,这也符合快速康复外科所追求的"无痛、无应激"的核心理念。     

������ȫθ�г����������ؽ��ǺϷ����ع��Զ����о�

??Comparison of the efficiency between two methods of alimentary tract reconstruction after robot-assisted total gastrectomy for gastric cancer DIAO Yan-qing, WANG Zhi-ming, JIANG Zhi-wei, et al. Research Institute of General Surgery of PLA, Nanjing General Hospital of Nanjing Military Region, Nanjing 210002, China
Corresponding author??JIANG Zhi-wei, E-mail??surgery34@163.com
Abstract Objective To compare the feasibility and difficulty between two methods of alimentary tract reconstruction after robot-assisted total gastrectomy for gastric cancer. Methods From April 2012 to April 2015??57 patients with gastric cancer in Nanjing General Hospital of Nanjing Military Region were enrolled for robot-assisted total gastrectomy and reconstruction of digestive tract??and all the operations were performed by the same surgeons. In 35 patients (group A)??reconstruction of alimentary canal was performed using single needle running by an absorbable suture. In the other 22 patients (group B), it was performed using two needle running by a barbed suture (180 Polyglyconate Absorbable Knotless Wound Closure Device). Several parameters were evaluated and compared in the two groups, such as time of operation, time of anastomosis, length of hospital stay, and the incidence rate of postoperative complications. In addition??the difficulty of anastomosis was assessed by the surgeon. Results All the 57 robot-assisted operations were completed successfully without conversion to open surgery. In group A??the total time of surgery was ??251.3±64.4??min??time of esophagojejunostomy was ??37.8±11.6??min??time of jejunojejunostomy was ??29.4±8.7??min??the time of postoperative hospital were ??5.5±3.7??days. In group B??the total time of surgery was ??192.8±52.9??min??time of esophagojejunostomy was ??18.1±7.9??min??time of jejunojejunostomy was ??14.6±6.3??min??the time of postoperative hospital were ??4.7±4.1?? days. Compared with group A??group B represented reduced difficulty in both operation and cooperation??significantly shorter time of the anastomosis?? surgery and postoperative hospital stay??P??0.05??. Furthermore??in group A there were two patients with anastomotic complications (anastomotic stricture)??but in group B they had declined (2/35 vs.0/22). Conclusion Both two kinds of anastomosis for alimentary canal reconstruction in robotic total gastrectomy are safe and feasible. The use of the barbed suture in totally robotic total gastrectomy would reduce the difficulty of reconstruction of digestive tract and save a lot of time of anastomosis??surgery and postoperative hospital stay.     

机器人全胃切除术消化道重建吻合方法回顾性对照研究

目的 比较机器人系统行胃癌全胃切除术中采用可吸收线连续缝合与免打结自固定缝线连续缝合两种镜下吻合方法的安全性、可行性及难易程度。方法　回顾性分析南京军区南京总医院2012年4月至2015年4月由同一术者实施达芬奇手术机器人胃癌全胃切除、全镜下消化道重建57例病人临床资料。按吻合方式分为可吸收线连续缝合组（A组,n=35）和免打结自固定缝线连续缝合组（B组,n=22）。分别比较两组的手术时间、吻合时间、住院时间以及术后并发症发生率,并由手术医师评估吻合的技术难度。结果 57例病人均完成手术,无一例中转开腹。A组总手术时间（251.3±64.4）min,食管空肠吻合时间（37.8±11.6）min,空肠空肠吻合时间（29.4±8.7）min,术后住院（5.5±3.7）d,术后发生吻合相关并发症共2例;B组总手术时间（192.8±52.9）min,食管空肠吻合时间（18.1±7.9）min,空肠空肠吻合时间（14.6±6.3）min,均比A组明显缩短（P＜0.05）,术后住院（4.7±4.1）d,少于A组（P＜0.05）,术后未发生吻合相关并发症,与A组相比有所下降（2/35 vs. 0/22）。经术者主观评估,B组的吻合技术难度低于A组,经第一助手主观评估,B组的配合难度也低于A组。结论 在机器人全胃切除术中两种吻合方法均安全、可行,免打结自固定缝线法降低了吻合的难度,明显缩短了吻合时间及总手术时间,并能减少病人术后的住院时间。     

���ٿ����������ָ����ǻ��θ���������ٴ���ֵ�о�

??Fast track surgery in laparoscopic gastrectomy for gastric cancer ZHAO Kun, WANG Gang, JIANG Zhi-wei, et al. Research Institute of General Surgery??Nanjing General Hospital of Nanjing Military Command PLA??Nanjing University School of Medicine, Nanjing 210002??China
Corresponding author ??JIANG Zhi-wei, E-mail??surgery34@163.com
Abstract Objective To evaluate the safety and effectiveness of fast track surgery in laparoscopic gastrectomy for gastric cancer. Methods The clinical data of 120 patients with gastric cancer performed gastrectomy between 2008 and 2011 in Nanjing General Hospital of Nanjing Military Command PLA were analyzed retrospectively. All patients received elective gastric cancer resection, and were divided into three groups?? group A (open gastrectomy, n=40) , group B (open gastrectomy with fast track surgery, n=40) and group C ( laparoscopic gastrectomy with fast track surgery, n=40). The clinical data and gut function were assessed in three groups. Results There were no significant differences in postoperative complication and the number of lymph node harvest between 3 groups. Blood loss was less in group C than group A and group B (P<0.01) , but its operative time was longer and its cost was more than other two open surgery groups (P<0.01). Recovery of bowel function in group C was faster, and postoperative hospital stay was shorter than group A (P<0.01). However, recovery of bowel function and postoperative hospital stay in group C were not different from group B (P>0.05). Conclusion Postoperative hospital stay can be shorter and recovery of bowel function can be faster in laparoscopic gastrectomy with fast track surgery plan compared with traditional care group. But when using fast track surgery plan, laparoscopic gastrectomy is not superior to open surgery.     

����������������븹ǻ����Զ��θ��������������Ч�����о�

??Contrast study of short-term effect between the Da Vinci surgical robot and laparoscopic technology in patients after distal gastric cancer surgery ZHAO Kun??PAN Hua-feng??WANG Gang??et al. Department of General Surgery, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China
Corresponding author:JIANG Zhi-wei,E-mail:surgery34@163.com
Abstract Objective To make a contrast between the Da Vinci surgical robot ( referred to as "robots") and laparoscopic technology in patients’ postoperative recovery after distal gastric cancer surgery. Methods Thirty robotic distal gastric cancer patients as robotic group and 30 laparoscopic gastric cancer patients as compared group both admitted from January 2012 to May 2012 in Nanjing General Hospital of Nanjing Military Command were analyzed. Perioperative situation was compared between the two groups. Results The robotic group was better than the laparoscopic group in intraoperative bleeding, the surgical incision length, postoperative incision pain and the first feeding time (P < 0.05). There was no statistical significance in lymph node dissection and postoperative complications. Conclusion Robot distal gastric cancer surgery is worthy of popularization and application for its less invasive surgery and quicker postoperative recover than laparoscopic surgery.     

��ǻ��ȫθ�г�����ͬʳ�ܿճ��ǺϷ����ٴ�Ӧ��̽��

??Clinical analysis of 7 methods of laparoscopic esophagojejunostomy after total gastrectomy WANG Wei, ZHENG Yan-sheng, XIONG Wen-jun, et al. Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
Corresponding author??WAN Jin??E-mail??gdphtcmwanjin@163.com
Abstract Objective To introduce 7 methods of laparoscopic esophagojejunostomy after total gastrectomy. Methods The clinical data of 93 patients with gastric caner underwent totally laparoscopic total gastrectomy and Roux-en-Y esophagojejunostomy from December 2011 to June 2015 in Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine were analyzed retrospectively. There were 5 methods of anvil insertion for circular stapling which containing reverse puncture device??anvil lateral insertion??anvil direct insertion??purse string suture and OrVilTM. For linear stapling??there were two methods namely Overlap and FETE. The operative time??blood loss and morbidity of different methods were reviewed. Results The mean operative time was ??293.7±85.3?? min with a mean esophagojejunostomy time of ??23.0±5.8?? mL. Anvil direct insertion was superior to the time of esophagojejunostomy with a mean esophagojejunostomy time of ??18.2±3.7??min. Intraoperative complication occurred in 4 patients and postoperative complication occurred in 3 patients. They were all cured with conservative methods. No death was recorded. Conclusion The 7 methods of totally laparoscopic esophagojejunostomy after total gastrectomy are safe and feasible.     

���ٿ��������������С�������г������о�����19�����棩

??The clinical use of fast track surgery in partial small intestinal resections WANG Gang??JIANG Zhi-wei??BAO Yang??et al. Research Institute of General Surgery??Clinical School of Medicine Nanjing University, Nanjing Hospital of Nanjing Command of PLA??Nanjing 210002??China
Corresponding author??JIANG Zhi-wei, E-mail: surgery34@163.com
Abstract Objective To investigate the effectiveness and safety of using fast track surgery in partial small intestinal resections. Methods The clinical data of 19 patients with small intestinal disease underwent partial small intestinal resections and fast track surgery (FTS) procedures at Clinical School of Medicine Nanjing University, Nanjing Hospital of Nanjing Command of PLA were analyzed retrospectively. The data included operative time, blood loss, length of incision, time for passage of flatus, postoperative hospital stay, operative complications and result of follow-up. Results All the patients were treated by partial intestinal resections. The mean operative time was (46.1±18.7) min. Blood loss volume was (19.1±14.2) mL. Length of incision was (3.6±1.2) cm. Time for passage of flatus was (26.6±8.7) h. Time for away from the bed was (9.5±5.2) h and postoperative hospital stay was (3.2±2.1) d. No lesions were missed and no operative complications and death occurred in all patients. Conclusion FTS could accelerate the recovery after partial small intestinal resection.     

������������ֱ��ǰ�г����������ϳ�ֱ���ٴ��о�

??Totally robotic surgery for rectal cancer with transanal specimen extraction ZHANG Xue-feng, LV Chi, ZHANG Cheng, et al. Department of General Surgery, General Hospital of Shenyang Military Region, Shenyang 110015, China
Corresponding author: LI Jin, E-mail: lvlinger92@gmail.com
Abstract Objective To investigate the clinical experience of transanal specimen extraction with robot-sewn anastomosis technique. Methods The clinical data of 16 cases performed rectal cancer resection by the da Vinci robotic system with transanal specimen extraction and robot-sewn anastomosis technique between July 2012 and December 2012 in General Hospital of Shenyang Military Region were analyzed retrospectively. Results There were 9 males and 7 females with age 46-84 years old??and BMI 18.8-28.8 kg/m2. All the cases??13 cases of rectal cancer, 2 cases of rectal villous tubular adenomas, 1 case of rectal carcinoid tumors?? were performed robotic surgery successfully without intraoperative conversion??The operative time was 160-610 min [mean (220.4±24.5)min]. The blood loss was below 50mL. The time to first flatus was 18-74 hours [mean (27.3±7.5)hours] postoperatively. The postoperative hospital stay was 5-10 days [mean (6.2±2.1)days]. The number of lymph node harvested from the surgical specimen was 2-39 (mean 18.2±7.6)??TNM stage: 2 cases of stage??, 7 cases of stage II, 4 cases of stage ??. All the resection margins were negative??There was no local surgical complication. Conclusion Totally robotic surgery for rectal cancer with transanal specimen extraction is safe and feasible.     

������ֱ����ǰ�г�������Ȼ�׵��ϳ��걾21������

??Trans-natural orifice transuminal specimen extraction in robotic rectal cancer surgery: An analysis of 21 patients RUAN Hu??LIU Jiang??ZHAO Kun??et al. Department of General Surgery??Affiliated Jinlin Hospital of Nanjing University Medicine College??Nanjing 210002??China
Corresponding author??JIANC Zhi-wei??E-mail??surgery34@163.com
Abstract Objective To discuss the safety and feasibility of transanal or vaginal specimen extraction in robotic rectal cancer surgery??Methods The clinical data of 21 patients who underwent robotic rectal cancer resection with transanal or vaginal specimen extraction from February 2012 to September 2013 in Affiliated Jinlin Hospital of Nanjing University Medicine College were analyzed retrospectively??Results There were 21 patients with a mean age of??62.5±7.8??years old??19 of them with transanal specimen extraction??others with vaginal specimen extraction. All the cases underwent robotic surgery successfully with no conversion??The average operative time was ??173.6±27.1?? min with a mean intraoperative blood loss of ??38.7±11.2??mL??The mean number of lymph node harvested was ??16.0±1.8????All the resection margins were negative??The first time to flatus was??1.9±0.4) days postoperatively??The postoperative hospital stay was ??4.2±1.3?? days??Conclusion Transanal or vaginal specimen extraction in robotic rectal cancer surgery is safe and feasible with preferable maneuverability and availability.     

θ����ȫ��ǻ��ȫθ�г���ʳ�ܿճ��ֹ����9������

??Totally laparoscopic total gastrectomy for gastric cancer with intracorporeal hand-sewn esophagojejunostomy??An analysis of 9 cases DAI Fa-xiang*??XUAN YI??YU Sheng-jia??et al. *Department of Gastric Cancer and Soft Tissue Sarcoma??Shanghai Cancer Center??Fudan University??Department of Oncology??Shanghai Medical College??Fudan University??Shanghai200032??China
Corresponding author??HUANG Hua??E-mail??huahuang@fudan.edu.cn
Abstract Objective To investigate the feasibility and safety of totally laparoscopic total gastrectomy (TLTG) with esophagojejunostomy intracorporeal hand-sewn reconstruction. Methods The clinical data of 9 cases underwent TLTG with esophagojejunostomy intracorporeal hand-sewn reconstruction between January 2015 and December 2015 in Shanghai Cancer Center??Fudan University was analyzed retrospectively. Results A total of 8 cases of suture succeeded while 1 case failed. The operation time was (209.9 ± 25.0) min. The anastomosis time was (51.9 ± 8.4) min. The amount of bleeding during surgery was (59.7 ± 12.6) mL. The first flatus time was (3.8 ± 1.2) d. The postoperative hospital stay was (8.9 ± 1.5) d. The postoperation recovered well without serious complications. Conclusion TLTG with esophagojejunostomy intracorporeal hand-sewn reconstruction is safe and feasible.