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机器人胃癌根治术消化道重建的技术难点及其对策

Technical difficulties and countermeasures of digestive tract reconstruction in robotic radical gastrectomy for gastric cancer

摘要:

机器人胃癌根治术中的消化道重建目前仍具有手术难度大、技术要求高等问题,本文结合福建医科大学附属协和医院胃外科的手术经验及国内外文献,围绕机器人远端胃癌根治术(Billroth Ⅰ式吻合、BillrothⅡ式吻合和Roux-en-Y式胃空肠吻合)、近端胃切除术后(双通道吻合和双肌瓣吻合)以及全胃切除术(Roux-en-Y吻合、功能性端对端吻合即FEEA、π式吻合、Overlap吻合及改良的延迟离断空肠的Overlap吻合即later-cut Overlap法)等相关问题进行了探讨。包括:(1)机器人胃癌根治术消化道重建方式选择的原则。(2)机器人远端胃癌根治术消化道重建:主要针对传统三角吻合存在的薄弱点,介绍了笔者所在中心对这一技术难点所进行的改良,即"改良三角吻合";并提出,由于BillrothⅡ式吻合是目前国内较为常用的吻合方式,机器人下手工缝合共同开口更加方便且安全,可以有效避免吻合口狭窄的发生。(3)机器人近端胃切除术消化道重建:主要包括双通道吻和双肌瓣吻合,但这些重建方式均较为复杂,目前机器人手术未能广泛开展。(4)机器人全胃切除术消化道重建:最经典的为Roux-en-Y吻合,其主要包括使用管型吻合器行食管空肠端侧吻合和使用直线切割闭合器行食管空肠侧侧吻合,本文针对存在的技术难点探讨了解决的措施。随着机器人手术系统、吻合器械的不断推陈出新以及吻合技术的逐步提高,相信机器人胃癌根治术后消化道重建在胃癌手术中将具有良好的应用前景。

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abstracts:

There still remain some problemsin digestive tract reconstruction after robotic radical gastrectomy for gastric cancer at present, such as great surgical difficulties and high technical requirements. Based on the surgical experience of the Gastric Surgery Department of Union Hospital, Fujian Medical University and the literatures at home and abroad, relevant issues are discussed in terms of robotic radical distal gastrectomy (Billroth I, Billroth II, and Roux-en-Y gastrojejunostomy), proximal gastrectomy (double-channel and double-muscle flap anastomosis), and total gastrectomy (Roux-en-Y anastomosis, functional end-to-end anastomosis, FEEA, π-anastomosis, Overlap anastomosis, and modified Overlap anastomosis with delayed amputation of jejunum, i.e. later-cut Overlap). This article mainly includes (1) The principles of digestive tract reconstruction after robotic radical gastrectomy for gastric cancer. (2) Digestive tract reconstruction after robotic radical distal gastrectomy: Aiming at the weakness of traditional triangular anastomosis, we introduce the improvement of the technical difficulty, namely "modified triangular anastomosis", and point out that because Billroth II anastomosis is a common anastomosis method in China at present, manual suture under robot is more convenient and safe, and can effectively avoid anastomotic stenosis. (3) Digestive tract reconstruction after robotic proximal gastrectomy: It mainly includes double channel anastomosis and double muscle flap anastomosis, but these reconstruction methods are relatively complicated, and robotic surgery has not been widely carried out at present. (4) Digestive tract reconstruction after robotic total gastrectomy: The most classic one is Roux-en-Y anastomosis, mainly using circular stapler for end-to-side esophagojejunal anastomosis and linear stapler for side-to-side esophagojejunal anastomosis, for which we discuss the solutions to the existing technical difficulties. With the continuous innovation of robotic surgical system and anastomosis instruments, and with the gradual improvement of anastomosis technology, it is believed that digestive tract reconstruction after robotic radical gastrectomy for gastric cancer will have a good application prospect in gastric cancer surgery.

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作者: 郑华龙 [1] 林嘉 [1] 黄昌明 [1]
期刊: 《中华胃肠外科杂志》2022年25卷5期 392-395页 MEDLINEISTICPKUCSCD
栏目名称: 专题论坛
DOI: 10.3760/cma.j.cn441530-20220304-00083
发布时间: 2022-07-31
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