全腹腔镜远端胃切除Overlap法BillrothⅠ式消化道重建探讨（附1例报告）

摘要

Objective To introduce the usage of Overlap method in Billroth I reconstruction of totally laparoscopic distal gastrectomy. Methods This study retrospectively analyzed 1 case of overlap BillrothⅠreconstruction for totally laparoscopic distal gastrectomy in Peking University Cancer Hospital and described the technique details of the method. Results In overlap BillrothⅠreconstruction, the duodenum bulb is transected in the caudal-to-cranial direction and then the cranial part of the transection line is opened. After transection of the stomach, the point of greater curvature 60mm from the transection line is opened. Then a 60mm linear stapler is used for the side-to-side anastomosis of gastric greater curvature and upper-lateral wall of duodenum. Finally, the conjuncture incision is closed with another linear stapler. Conclusion The overlap BillrothⅠreconstruction method for totally laparoscopic distal gastrectomy is simple to operate and the digestive tract is not twisted which may contribute to faster recovery of bowel function.%目的：探讨全腹腔镜下远端胃切除术采用Overlap方法进行残胃十二指肠Billroth I式消化道重建。方法回顾分析北京大学肿瘤医院胃肠肿瘤中心采用该方法进行消化道重建的1例病人临床资料。结果Overlap法Billroth I式重建中，按照从尾侧向头侧的方向离断十二指肠球部后在十二指肠离断线头侧开口。离断远端胃后，在胃大弯离断线近端60 mm处开口。之后采用60 mm直线吻合器将近端胃大弯侧和十二指肠上外侧壁进行侧侧吻合。最后利用直线吻合器关闭共同开口。结论全腹腔镜下使用直线吻合器进行Overlap法Billroth I式消化道重建操作简单易行，吻合后消化道无明显扭转，在术后功能恢复方面可能具有优势。