全腹腔鏡下胃癌根治術(shù)消化道重建

學(xué)習(xí)實(shí)踐

廣東省人民醫(yī)院/廣東省醫(yī)學(xué)科學(xué)院胃腸外科/胃腸腫瘤外科李勇全腹腔鏡下胃癌根治術(shù)消化道重建

學(xué)習(xí)實(shí)踐

廣東省人民醫(yī)院/廣HistoryofreconstructionmethodsVariationsofB-I,B-II,RYprocedures@Hyung-HoKimHistoryofreconstructionmeth腹腔鏡下遠(yuǎn)端胃切除消化道重建BillrothI式：三角吻合BillrothII胃空腸吻合：順蠕動(dòng)，逆蠕動(dòng)胃空腸Roux-en-Y吻合腹腔鏡下遠(yuǎn)端胃切除消化道重建BillrothI式：三角吻BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)2022/11/232022/11/222022/11/232022/11/22胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合全器械吻合胃空腸Roux-en-Y吻合全器械吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合大學(xué)課件：全腔鏡下胃癌根治術(shù)的消化道重建ApplicationofUncutRoux-en-YgastrojejunostomyinTLGGuangdongGeneralHospitalGuangdongAcademyofMedicalScienceGastrointestinalsurgeryYongLi,DeqingWu,XingyuFengApplicationofUncutRoux-en-Y大學(xué)課件：全腔鏡下胃癌根治術(shù)的消化道重建大學(xué)課件：全腔鏡下胃癌根治術(shù)的消化道重建HistoryofUncutRoux-en-Y(URY)StiegmannandGoffreportedthistechniquefortreatmentofbilerefluxgastritisin1988Morrisonetal.andMiedemareportedthatthismethodpreservedgastricemptyingandpreventedtheRouxstasissyndrome.SurgGynecolObstet1988;166:69–70.AmJSurg1990;160:252–6ArchSurg1992;127:295–300HistoryofUncutRoux-en-Y(URYMethodsofURYIIIIIIMethodsofURYIIIIIIApplicationofURYinLADGUyamaetal.“ApplicationofURYinLaparoscopy-assisteddistalgastrectomy“inGastricCancer(2005)8:253–257Uyamaetal.200542

patientsunderwenttheURYreconstruction.Thereconstructiontookameantimeof46mins.Postoperativegastricstasis6ofthe54patients(11%)intheconventionalRouxoperationgroup2

ofthe42patients(4.8%)intheuncutRouxoperationgroupP<0.05ApplicationofURYinLADGUyamApplicationofURYinTLGNK45ApplicationofURYinTLGNK45OurexperienceofURYinTLGOurexperienceofURYinTLG大學(xué)課件：全腔鏡下胃癌根治術(shù)的消化道重建OurexperienceofURYinTLGGDARGACHALGAGCVPHAOurexperienceofURYinTLGGDOurexperienceofURYinTLG213312OurexperienceofURYinTLG21546654OurexperienceofURYinTLG546654OurexperienceofURYinOurexperienceofURYinTLGVEDIOOurexperienceofURYinTLGVEOurexperienceofURYinTLG不同阻斷輸入袢的方法OurexperienceofURYinTLG不同OurexperienceofURYinTLG不同阻斷方法術(shù)后輸入袢蠕動(dòng)的比較OurexperienceofURYinTLG不同OurexperienceofURYinTLGOurexperienceofURYinTLGMethods30patientswhounderwentTLGin6hospitalofChinabetweenFebruary2014andJanuary2015wereenrolledinthisstudy.

operation

method:distalgastrectomy+D2lymphadenectomy+UncutRoux-en-Yreconstruction(TLG)Male19,Female11Meanage：56.1Methods30patientswhounderweResultsnumberofresectionLN

:36.9±9.0Length

ofincision:4.8±1.18cmOperatontime:223.5±47.2minReconstructiontime:52.8±10.9minEstimatedbloodloss:53±30.7mlOpenconversion(person):0retain

time

of

gastric

tuber：2.5±1.2daysretain

time

ofcatheter:1.9±1daysFirstflatus:2.9±0.9daysLiquiddiet:2.9±1.2daysComplication(person):2Theblocksite

ofreopen(person):2Motality(person):0ResultsnumberofresectionLN

ConclusionUncutRoux-en-YgastrojejunostomyinTLGissafeandfeasible.

shorteroperatingtimeandanastomotictime,lessbleeding,fasterpatientrecovery.TheadvantageofpreventingtheRouxstasissyndromeneedmorefollow-up

information.Theblocksiteof

jejunummayreopeninsomepatients.ConclusionUncutRoux-en-YgastOurclinicaltrailVSOurclinicaltrailVSCONCLUSION1、倫理性：URY源于傳統(tǒng)的手術(shù)畢II式吻合加布朗斯吻合以及ROUX-EN-Y手術(shù)的技巧2、可行性：URY在腹腔鏡技術(shù)上講的可行的3、安全性：我們沒(méi)有觀察到手術(shù)的患者出現(xiàn)了吻合口漏、腹腔出血和吻合口狹窄的情況4、我們需要更多的病例和隨訪的數(shù)據(jù)CONCLUSION1、倫理性：URY源于傳統(tǒng)的手術(shù)畢II式AcknowledgementsRuiJinHospitalShangHaiJiaoTongUniversitySchoolOfMedicineFuJianProvincialCancerHospital(FPCH)JiangSuProvinceHospital(TheFirstAfflicatedHospitalofNanJingMedicalSchool)TheSecondHospitalBethuneOfJiLinUniversityBeiJingCancerHospitalAcknowledgementsRuiJinHospit全腔鏡下全胃切除胃癌D2根治食管空腸吻合術(shù)Orvil輔助管型吻合器食管空腸端側(cè)吻合法反穿刺技或手工荷包管型吻合器食管空腸端側(cè)吻合法食管空腸直線切割器側(cè)側(cè)吻合（FEE法）倒T型食管空腸直線切割器側(cè)側(cè)吻合法（Tshape）食管空腸直線切割器側(cè)側(cè)交疊吻合法（Over-Lap）改良型食管空腸直線切割器側(cè)側(cè)交疊吻合法全腔鏡下全胃切除胃癌D2根治食管空腸吻合術(shù)Orvil輔助管型Orvil輔助食管空腸端側(cè)吻合Orvil輔助食管空腸端側(cè)吻合反穿刺技術(shù)食管空腸端側(cè)吻合反穿刺技術(shù)食管空腸端側(cè)吻合食管空腸側(cè)側(cè)吻合(FEE)食管空腸側(cè)側(cè)吻合(FEE)食管空腸側(cè)側(cè)吻合(FEE)食管空腸側(cè)側(cè)吻合(FEE)倒T型食管空腸側(cè)側(cè)吻合法(TSHAPE)Feasibilityandsafetyofintracorporealesophagojejunostomyafterlaparoscopictotalgastrectomy:InvertedT-shapedanastomosisusinglinearstaplers.EishiNagai,et.Kyushu,Japan.倒T型食管空腸側(cè)側(cè)吻合法(TSHAPE)Feasibili倒T型食管空腸側(cè)側(cè)吻合法(TSHAPE)倒T型食管空腸側(cè)側(cè)吻合法(TSHAPE)食管空腸側(cè)側(cè)交疊吻合法(Over-Lap)食管空腸側(cè)側(cè)交疊吻合法(Over-Lap)改良型食管空腸側(cè)側(cè)交疊吻合法改良型食管空腸側(cè)側(cè)交疊吻合法改良型食管空腸側(cè)側(cè)交疊吻合法改良型食管空腸側(cè)側(cè)交疊吻合法改良型食管空腸側(cè)側(cè)交疊吻合法改良型食管空腸側(cè)側(cè)交疊吻合法THANKSFORYOURATTENTIONTHANKSFORYOURATTENTION全腹腔鏡下胃癌根治術(shù)消化道重建

學(xué)習(xí)實(shí)踐

廣東省人民醫(yī)院/廣東省醫(yī)學(xué)科學(xué)院胃腸外科/胃腸腫瘤外科李勇全腹腔鏡下胃癌根治術(shù)消化道重建

學(xué)習(xí)實(shí)踐

廣東省人民醫(yī)院/廣HistoryofreconstructionmethodsVariationsofB-I,B-II,RYprocedures@Hyung-HoKimHistoryofreconstructionmeth腹腔鏡下遠(yuǎn)端胃切除消化道重建BillrothI式：三角吻合BillrothII胃空腸吻合：順蠕動(dòng)，逆蠕動(dòng)胃空腸Roux-en-Y吻合腹腔鏡下遠(yuǎn)端胃切除消化道重建BillrothI式：三角吻BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：順蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)BillrothII胃空腸吻合：逆蠕動(dòng)2022/11/232022/11/222022/11/232022/11/22胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合全器械吻合胃空腸Roux-en-Y吻合全器械吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合胃空腸Roux-en-Y吻合大學(xué)課件：全腔鏡下胃癌根治術(shù)的消化道重建ApplicationofUncutRoux-en-YgastrojejunostomyinTLGGuangdongGeneralHospitalGuangdongAcademyofMedicalScienceGastrointestinalsurgeryYongLi,DeqingWu,XingyuFengApplicationofUncutRoux-en-Y大學(xué)課件：全腔鏡下胃癌根治術(shù)的消化道重建大學(xué)課件：全腔鏡下胃癌根治術(shù)的消化道重建HistoryofUncutRoux-en-Y(URY)StiegmannandGoffreportedthistechniquefortreatmentofbilerefluxgastritisin1988Morrisonetal.andMiedemareportedthatthismethodpreservedgastricemptyingandpreventedtheRouxstasissyndrome.SurgGynecolObstet1988;166:69–70.AmJSurg1990;160:252–6ArchSurg1992;127:295–300HistoryofUncutRoux-en-Y(URYMethodsofURYIIIIIIMethodsofURYIIIIIIApplicationofURYinLADGUyamaetal.“ApplicationofURYinLaparoscopy-assisteddistalgastrectomy“inGastricCancer(2005)8:253–257Uyamaetal.200542

patientsunderwenttheURYreconstruction.Thereconstructiontookameantimeof46mins.Postoperativegastricstasis6ofthe54patients(11%)intheconventionalRouxoperationgroup2

ofthe42patients(4.8%)intheuncutRouxoperationgroupP<0.05ApplicationofURYinLADGUyamApplicationofURYinTLGNK45ApplicationofURYinTLGNK45OurexperienceofURYinTLGOurexperienceofURYinTLG大學(xué)課件：全腔鏡下胃癌根治術(shù)的消化道重建OurexperienceofURYinTLGGDARGACHALGAGCVPHAOurexperienceofURYinTLGGDOurexperienceofURYinTLG213312OurexperienceofURYinTLG21546654OurexperienceofURYinTLG546654OurexperienceofURYinOurexperienceofURYinTLGVEDIOOurexperienceofURYinTLGVEOurexperienceofURYinTLG不同阻斷輸入袢的方法OurexperienceofURYinTLG不同OurexperienceofURYinTLG不同阻斷方法術(shù)后輸入袢蠕動(dòng)的比較OurexperienceofURYinTLG不同OurexperienceofURYinTLGOurexperienceofURYinTLGMethods30patientswhounderwentTLGin6hospitalofChinabetweenFebruary2014andJanuary2015wereenrolledinthisstudy.

operation

method:distalgastrectomy+D2lymphadenectomy+UncutRoux-en-Yreconstruction(TLG)Male19,Female11Meanage：56.1Methods30patientswhounderweResultsnumberofresectionLN

:36.9±9.0Length

ofincision:4.8±1.18cmOperatontime:223.5±47.2minReconstructiontime:52.8±10.9minEstimatedbloodloss:53±30.7mlOpenconversion(person):0retain

time

of

gastric

tuber：2.5±1.2daysretain

time

ofcatheter:1.9±1daysFirstflatus:2.9±0.9daysLiquiddiet:2.9±1.2daysComplication(person):2Theblocksite

ofreopen(person):2Motality(person):0ResultsnumberofresectionLN

ConclusionUncutRoux-en-YgastrojejunostomyinTLGissafeandfeasible.

shorteroperatingtimeandanastomotictime,lessbleeding,fasterpatientrecovery.TheadvantageofpreventingtheRouxstasissyndromeneedmorefollow-up

information.Theblocksiteof

jejunummayreopeninsomepatients.ConclusionUncutRoux-en-YgastOurclinicaltrailVSOurclinicaltrailVSCONCLUSION1、倫理性：URY源于傳統(tǒng)的手術(shù)畢II式吻合加布朗斯吻合以及ROUX-EN-Y手術(shù)的技巧2、可行性：URY在腹腔鏡技術(shù)上講的可行的3、安全性：我們沒(méi)有觀察到手術(shù)的患者出現(xiàn)了吻合口漏、腹腔出血和吻合口狹窄的情況4、我們需要更多的病例和隨訪的數(shù)據(jù)CONCLUSION1、倫理性：URY源于傳統(tǒng)的手術(shù)畢II式Acknowledgemen