食管-胃"程氏Giraffe重建术"在食管胃结合部腺癌近端胃切除后消化道重建患者中应用的初步疗效分析  

Preliminary efficacy analysis of Cheng's Giraffe reconstruction after proximal gastrectomy in adenocarcinoma of esophagogastric junction

作　　者：程向东[1] 徐志远[1] 杜义安[1] 胡灿 余建法[2] 杨立涛[1] 黄灵[1] 俞鹏飞[1] 戴丐国[1] 张延强 Cheng Xiangdong;Xu Zhiyuan;Du Yi′an;Hu Can;Yu Jianfa;Yang Litao;Huang Ling;Yu Pengfei;Dai Gaiguo;Zhang Yanqiang(Department of Abdominal Surgery,Zhejiang Cancer Hospital,Hangzhou 310022,China;Department of Gastrointestinal Surgery,The First Affiliated Hospital,Zhejiang University of Traditional Chinese Medicine,Hangzhou 310006,China)

机构地区：[1]浙江省肿瘤医院腹部外科,杭州310022 [2]浙江中医药大学附属第一医院胃肠外科,杭州310006

出　　处：《中华胃肠外科杂志》2020年第2期158-162,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：浙江省中医药科技计划-重点研究项目(2016ZZ012);浙江省自然科学基金项目(LY16H280011、LY18H290006);浙江省医药卫生科技项目(WKJ-ZJ-1728、2016KYB220)。

摘　　要：目的探讨早期SiewertⅡ型食管胃结合部腺癌(AEG)行近端胃切除后食管-胃"程氏Giraffe重建术"安全性及可行性。方法"程氏Giraffe重建术"适用范围:(1)SiewertⅡ型和肿瘤长径<4 cm的SiewertⅢ型AEG患者;(2)术前临床分期:cT1~2N0M0。采用描述性系列病例研究的方法。收集2018年2—7月期间在浙江省肿瘤医院腹部肿瘤外科及浙江中医药大学附属第一医院胃肠外科行近端胃切除后采用食管-胃"程氏Giraffe重建术"的34例AEG患者临床资料。所有患者均为SiewertⅡ型AEG;TNM分期:ⅠA期14例,ⅡA期11例,ⅡB期8例。食管-胃"程氏Giraffe重建术"简要步骤:距离胃大弯边缘4 cm处纵行切割形成12 cm长的管状胃;在距最远端2 cm处垂直离断胃小弯,形成胃底和His角;保证距离His角5 cm以上作食管-管状胃吻合。术后通过随访胃食管反流症状量表(RDQ)评分、检测核素胃排空试验和食管24 h多通道腔内阻抗(MII)-pH来整体评估残胃动力和抗反流情况。结果34例患者均顺利完成近端胃切除后食管-胃"程氏Giraffe重建术",开腹手术13例,腹腔镜手术21例。手术时间(144.6±39.8)min,术中出血(35.4±17.2)ml,腹腔镜手术中未发生中转开腹现象。术后无并发症发生,术后住院时间为(8.4±2.5)d。术后1个月RDQ评分为(4.4±3.1)分,术后6个月为(3.3±2.5)分;术后1个月核素胃排空试验显示,胃半排空时间为(67.0±21.5)min,1 h、2 h和3 h胃残余率分别为(52.2±7.7)%、(36.4±3.1)%和(28.8±3.6)%,术后2个月食管24 h MII-pH监测显示,酸反流总次数为(12.6±7.9)次,非酸反流总次数(19.6±9.7)次,DeMeester评分为(5.8±2.9)分。结论"程氏Giraffe重建术"在行近端胃切除的Ⅱ型AEG患者中应用是安全可行的,具有良好的动力及抗反流效果。Objective To investigate the safety and feasibility of proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction for the treatment of early Siewert II adenocarcinoma of esophagogastric junction(AEG).Methods Indication of Cheng's Giraffe esophagogastric reconstruction:(1)Siewert II AEG or Siewert III AEG with diameter<4 cm;(2)preoperative staging as cT1-2N0M0.A descriptive case series study was carried out.Clinical data of 34 patients with Siewert II AEG undergoing proximal partial gastrectomy and Cheng's Giraffe esophagogastric reconstruction at Department of Abdominal Surgery of Zhejiang Cancer Hospital and Department of Gastrointestinal Surgery,The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from February to July 2018 were retrospectively collected and analyzed,including 14 cases in IA stage,11 cases in IIA stage and 8 cases in IIB stage.Brief procedure of Cheng's Giraffe esophagogastric reconstruction was as follows:Firstly,12 cm long tubular stomach was formed by longitudinal incision 4 cm away from the great curvature of the stomach.Secondly,the gastric fundus and His angle were formed.Finally,the distance from His angle to esophagal-tubular gastric anastomosis should be more than 5 cm.The reflux disease questionare(RDQ)scores,radionuclide gastric emptying scintigraphy,and 24-hour multichannel intraluminal(MII)-pH monitoring technology were used to evaluate postoperative gastric emptying and gastroesophageal reflux.Result All 34 patients successfully completed proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction,including 13 cases by open surgery and 21 cases by laparoscopic surgery.The operation time was(144.6±39.8)minutes,the blood loss during operation was(35.4±17.2)ml.No laparoscopic case was converted to open surgery and no postoperative complication was observed.The postoperative hospital stay was(8.4±2.5)days.The postoperative RDQ score was 4.4±3.1 one month after operation,and 3.3±2.5 six months after operati

关 键 词：食管胃结合部腺癌 食管-胃程氏Giraffe重建 胃切除术 近端 胃食管反流 

分 类 号：R735[医药卫生—肿瘤]