Objective: To assess the safety and feasibility of Bi's intestinal loop binding treatment of esophageal jejunal anastomotic leak after total gastrectomy. Methods: Bi's Intestinal loop binding are suitable for patients who underwent radical total gastrectomy+Roux-en-Y anastomosis and were confirmed by upper gastrointestinal angiography to have esophageal jejunal anastomotic leakage and whose conservative or endoscopic treatment was ineffective. The operation procedure is as follows: take the original central incision of the upper abdomen, remove the abscess around the anastomoses after ventral incision, and place drainage tube inside the abscess, which is convenient to rinse and drain after operation. A double 1-0 VICRYL is applied to the loop of gastrointestinal surrogate 10-15 cm proximal to the jejuno-jejunal anastomosis. The knot tension is tight to prevent regurgitation of digestive juices, but too much force should be avoided to cut the intestinal tract. Nutritional jejunostomy fistula was performed at 10‒15 cm distal to the jejuno-jejunal anastomosis and gastric tube was retained during the operation. The preoperative and postoperative data from 12 patients with jejunal esophageal anastomotic leak after total radical gastrectomy and Roux-en-Y anastomosis were retrospectively analyzed from October 2016 to January 2023 in gastrointestinal surgery and pancreas surgery at Shanxi People's Hospital, and observed the curative effect. Results: 12 patients were managed with Bi's Intestinal loop binding, operative time (60.0±20.8) minutes, median bleeding (50±10.8) ml, median hospital stay 20(12~28) days, and median reviewing upper and mid Gastrointestinal Contrast time postoperatively 61(52~74) days. The results showed that the anastomoses healed well, all the small intestine showed good imaging, the binding wire fell off by itself, and two patients had incision infection. Conclusions: It is safe and feasible for patients with esophageal jejunostomy fistulae after total gastrectomy to use the method of Bi's Intestinal loop binding.
目的： 探讨应用毕式捆扎法治疗全胃切除术后食管空肠吻合口漏患者的安全性及可行性。 方法： 毕式捆扎法适用于根治性全胃切除+Roux-en-Y吻合术后，经上消化道造影检查证实为食管空肠吻合口漏，或经保守治疗或内镜治疗无效的患者。其手术步骤如下：取原上腹部正中切口，进腹后分离粘连，清除吻合口周围感染灶，感染灶内可置引流管，便于术后冲洗引流。距空肠-空肠吻合口近端10~15 cm的代胃肠袢行双1-0薇荞线捆扎，打结张力较紧以阻止消化液反流，但要避免用力过大切割肠管。术中于空肠-空肠吻合口远端10~15 cm处行营养性空肠造瘘，术中留置胃管。采用描述性病例系列研究方法，回顾性分析2016年10月至2023年1月期间，山西省人民医院胃肠胰外科对12例行根治性全胃切除、Roux-en-Y吻合术后食管空肠吻合口漏患者，实施毕式捆扎法的术前及术后病例资料，观察其疗效。 结果： 12例患者均顺利实施毕式捆扎法，手术时间（60.0±20.8）min，术中出血量（50.0±10.8）ml。术后中位住院时间为20（12~28）d，术后复查上中消化道造影中位时间61（52~74）d，吻合口愈合良好，2例患者出现切口感染，余无其他并发症发生。 结论： 全胃切除术后出现食管空肠吻合口漏患者，经保守治疗或内镜无效，应用毕式捆扎法是安全可行的。.