全胃切除与近端胃切除术后消化道重建方式的选择与思考  

Choice and consideration of digestive tract reconstruction after total gastrectomy and proximal gastrectomy

作　　者：李乐平[1] 崔怀平 商亮 Li Leping;Cui Huaiping;Shang Liang(Department of Gastroenterology,Shandong Provincial Hospital,Laboratory of Digestive Tumor Translational Medicine Engineering of Shandong Province,Ji'nan 250021,China)

机构地区：[1]山东省立医院胃肠外科,山东省消化肿瘤转化医学工程实验室,济南250021

出　　处：《中华消化外科杂志》2021年第6期643-647,共5页Chinese Journal of Digestive Surgery

基　　金：山东省重点研发计划(重大科技创新工作)(2019jzzy010104);山东省重点研发计划(2019GSF108146);山东第一医科大学学科提升计划。

摘　　要：目前,对于胃上部癌,包括食管胃结合部癌的手术治疗,主要包括全胃切除术和近端胃切除术两种方式。全胃切除术后,将食管和空肠进行消化道重建,病人术后常面临进食效果较差和营养不良风险。与全胃切除术比较,近端胃切除术可保留部分胃组织,但由于破坏食管下括约肌生理结构,病人术后反流风险较高。为解决反流问题,目前临床中有多种改良的近端胃切除术后消化道重建方式。由于缺乏足够的理论研究支持,目前对于胃癌行全胃切除术或近端胃切除术,以及术后消化道重建方式选择仍存在争议。笔者梳理和思考全胃切除术和近端胃切除术后消化道重建的理念方法和研究进展,期望为临床工作提供理论依据。At present,the surgical treatment of upper gastric cancer,including esophago-gastric junction cancer,mainly includes the total gastrectomy and proximal gastrectomy.After total gastrectomy,the reconstruction of digestive tract is completed through the anastomosis of esophagus and jejunum.Patients undergoing total gastrectomy often face the risk of poor eating effect and malnutrition.Compared with total gastrectomy,the proximal gastrectomy can preserve part of the gastric tissue,but due to the loss of the normal physiological structure of the cardia,patients have a higher risk of postoperative reflux.In order to solve the problem of reflux,there are many improved operation methods of digestive tract reconstruction after proximal gastrectomy.At present,the choice of total gastrectomy or proximal gastrectomy and the operation methods of digestive tract reconstruction is still controversial.Because of the lack of sufficient theoretical research support.The authors comb the research progress and consider the concept and method of digestive tract reconstruction after total gastrectomy and proximal gastrectomy,in order to provide theoretical basis for clinical work.

关 键 词：胃肿瘤 全胃切除术 近端胃切除术 消化道重建 手术方式 思考 

分 类 号：R735.2[医药卫生—肿瘤]