近端胃切除术后胃肠道重建中的改良双牵引重建术

Yingying Li, Jian Wu, Ming Han, Wenbin Li, Zhibin Bi
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引用次数: 0

摘要

研究目的研究设计:病例系列。研究地点和时间:山西省长治医学院附属和济医院胃肠外科,2022年1月至11月:根据纳入和排除标准,本研究共纳入21例食管胃交界癌或近端胃癌患者,他们均接受了腹腔镜近端胃切除术,并进行了改良双通道吻合术。切除近端胃后,剩余的胃被塑造成管状。食道远端与空肠吻合。空肠在距食管空肠吻合口 10-15 厘米处与胃前壁吻合,吻合口在距残胃 3 厘米处。对手术时间、吻合时间、术中失血量、口服时间、住院时间和术后并发症等一般数据进行了评估。术后还进行了胃镜检查和胃肠造影,以评估残胃蠕动和抗反流效果:所有21名患者均接受了改良双通道吻合术。平均手术时间为 254(211 - 297)分钟。平均重建时间为 65(60 - 70)分钟。平均清除了19(15 - 29)个淋巴结。术中平均失血量为 86(78.5-105 毫升)。平均口服时间为 6(5 - 6.5)天。术后有两例肺部感染。没有发生吻合口狭窄、吻合口出血或渗漏。术后 6 个月的胃肠道造影检查显示,3 例患者的胃肠道蠕动减弱,其余患者的残余胃蠕动良好。术后 6 个月的胃镜检查仅发现一例反流性食管炎:结论:改良双通道吻合术用于近端胃切除术是安全可行的。结论:改良双通道吻合术用于近端胃切除术是安全可行的,它具有良好的抗反流效果和胃排空功能,同时不会增加术后并发症的风险:食管胃交界腺癌 上胃癌 近端胃切除术 双通道重建
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Modified Double-Tract Reconstruction in Gastrointestinal Reconstruction after Proximal Gastrectomy.

Objective: To determine the clinical efficacy and safety of modified double-channel anastomosis for digestive tract reconstruction in proximal gastrectomy for early gastric cancer (EGC).

Study design: Case series. Place and Duration of the Study: Department of Gastrointestinal Surgery, Heji Hospital, Changzhi Medical College, Shanxi, China, from January to November 2022.

Methodology: Based on inclusion and exclusion criteria, this study included a total of 21 patients with oesophagogastric junction cancer or proximal gastric cancer who underwent laparoscopic proximal gastrectomy with modified double-channel anastomosis. After resection of the proximal stomach, the remaining stomach was shaped into a tube. The distal end of the oesophagus was anastomosed to the jejunum. The jejunum was anastomosed 10-15 cm from the oesophagojejunostomy site laterally to the anterior wall of the stomach 3 cm from the gastric remnant. General data including operative time, anastomosis time, intraoperative blood loss, time to oral intake, length of hospital stay, and postoperative complications were evaluated. Postoperative gastroscopy and gastrointestinal imaging were performed to assess the residual stomach motility and anti-reflux effect.

Results: All twenty-one patients underwent modified double-channel anastomosis. The mean operation time was 254 (211 - 297) minutes. Mean reconstruction time was 65 (60 - 70) minutes. A mean of 19 (15 - 29) lymph nodes were cleared. Mean intraoperative blood loss was 86 (78.5-105ml). Mean time to oral intake was 6 (5 - 6.5) days. Postoperatively, there were two cases of pulmonary infection. There was no occurrence of anastomotic stenosis, anastomotic bleeding, or leakage. Gastrointestinal contrast study at 6 months postoperatively revealed reduced gastrointestinal motility in three cases and good residual gastric motility observed in the remaining patients. Gastroscopic examination at 6 months postoperatively revealed only one case of reflux oesophagitis.

Conclusion: Modified double-channel anastomosis for proximal gastrectomy is safe and feasible. It provides a good anti-reflux effect and gastric emptying function without increasing the risk of postoperative complications.

Key words: Adenocarcinoma of the oesophagogastric junction, Upper gastric carcinoma, Proximal gastrectomy, Double-tract reconstruction.

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