摘要随着腹腔镜技术和器械的不断发展,全腹腔镜下胃癌根治术在临床广泛开展,主要包括全腹腔镜下近端胃重建术、远端胃癌根治术和全胃切除术等,消化道重建是全腹腔镜下胃癌根治术的关键环节,也是手术的难点所在.全腹腔镜下手术较小切口辅助手术创伤更小,手术视野更加开阔.目前,全腹腔镜下胃癌根治术的可行性和安全性已得到初步证实.在保证肿瘤根治性前提下,以最少的创伤与最安全的吻合给患者带来最大获益是全腹腔镜手术发展方向.全腹腔镜远端胃癌根治术消化道重建方式主要为Billroth?Ⅰ式三角吻合、Billroth?Ⅱ式吻合和胃空肠Roux?en?Y吻合.Billroth?Ⅰ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,Billroth?Ⅱ式+Braun吻合与非离断(Uncut)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.全腹腔镜下近端胃重建术包括食管残胃吻合、食管管状胃吻合和间置空肠吻合等.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.为更好的服务于临床,本文就各术式的腔内吻合技术和消化道重建进展进行综述,为临床医生提供选择参考.

abstractsWith the development of laparoscopic skills and instruments,totally laparoscopic gastrectomy for gastric cancer has become widely used in the clinic,mainly including totally laparoscopic proximal gastric reconstruction,distal gastrectomy for gastric cancer and total gastrectomy. Digestive tract reconstruction is the key procedure of totally laparoscopic gastrectomy for gastric cancer. Totally laparoscopic surgery has less trauma and better visualization than reconstruction in a small incision. At present,feasibility and safety of totally laparoscopic gastrectomy for gastric cancer have been preliminarily confirmed. However,higher level of evidence is needed for the evaluation of long?term oncologic efficacy. In the future,it is possible for patients to best benefit from totally laparoscopic surgery with minimal trauma, safe anastomosis under the principle of radical resection of gastric cancer. The digestive tract reconstruction includes Delta anastomosis (Billroth I) ,Billroth II anastomosis,and gastrojejunal Roux?en?Y anastomosis in totally laparoscopic distal gastrectomy (TLDG). Billroth I with delta anastomosis has strict indications in TLDG. Gastrojejunal Roux?en?Y anastomosis is now more popular. Billroth II with Braun anastomosis and uncut Roux?en?Y anastomosis is technically easier to carry out in TLDG than Roux ? en ? Y. Totally laparoscopic proximal gastric reconstruction includes esophagogastric stump anastomosis,esophagogastric tubular anastomosis and interposition jejunostomy. The digestive tract reconstruction includes anastomosis using linear stapler and circular stapler in totally laparoscopic total gastrectomy (TLTG). In order to better serve the clinic,we review the progress of different endoscopic anastomotic techniques and digestive tract reconstruction.