左上腹切口与正中切口应用OrVil吻合器行腹腔镜食管空肠吻合术的比较

目的 探讨左上腹切口和正中切口应用OrVil吻合器行腹腔镜全胃切除食管空肠吻合术中的差异.方法 2010年10月～ 2013年3月,对36例应用OrVil吻合器进行腹腔镜全胃切除食管空肠吻合术患者,分别采用左上腹切口(n=23)或正中切口(n=13),对抵钉座放置时间、腔镜下吻合时间、术中出血量、切口长度、腹腔感染率、切口感染率、吻合口漏或狭窄等进行比较.结果 与正中切口组相比,左上腹切口组腔镜下吻合时间短[(7.4±2.2) min vs.(16.0 ±4.4)min,t=-7.965,P=0.000],切口短[(6.3±1.5)cm vs.(8.2±2.4)cm,t=-2.625,P=0.018],抵钉座放置时间、术中出血量、腹腔感染率、切口感染率、吻合口并发症差异无显著性(P＞0.05).结论 采用左上腹切口应用OrVil吻合器行腹腔镜食管空肠吻合术更为简便快捷、安全,但应注意保护切口及注意吻合时的对线、对位等操作技巧.

Comparison of Upper Abdominal Incision and Midline Incision in Laparoscopic Esophagojejunostomy Using OrVil System

Objective To explore the differences of upper abdominal incision and midhne recision m laparoscoplc esophagojejunostomy using OrVil system. Methods The clinical data of patients who received laparoseopic esophagojejunostomy after total gastrectomy using OrVil system by left upper abdominal incision （ n = 23 ） or midline incision （ n = 13 ） from October 2010 to March 2013 were compared. The anvil inserting time, endoscopic anastomosis time, blood loss, incision length, abdominal infection, incision infection, anastomotic leakage or stenosis and other complications were compared and analyzed. Results The endoscopic anastomosis time was significantly lower in the left upper abdominal incision group than in the midline incision group [ （714 ± 2.2） rain vs. （ 16.0 ± 4.4） min, t = - 7. 965, P = 0. 000 ] , and the length of the incision was shorter [ （6.3 ± 1.5） cm vs （8.2 ± 2.4） cm, t = -2. 625, P = 0. 018 ]. No significant differences could be found in the average anvil inserting time, blood loss, abdominal infection rate, incision infection rate and anastomotic complications between the two groups （P 〉 0. 05 ）. Conclusion Laparoscopic esophagojejunostomy using OrVil system by left upper abdominal incision is simpler, safer and more feasible, meanwhile, attention should be paid to the incision and specific techniques in anastomosis such as alignment.