改良Overlap食管-管型胃消化道重建在完全腹腔镜根治性近端胃切除术中的应用价值  

Application value of modified Overlap esophagogastric tube reconstruction in totally laparos-copic radical proximal gastrectomy

作　　者：马志明[1] 刘天舟[1] 李金龙[1] 高健 史常赛 陈佳乐 焦思敏 王旭东[1] Ma Zhiming;Liu Tianzhou;Li Jinlong;Gao Jian;Shi Changsai;Chen Jiale;Jiao Simin;Wang Xudong(Department of Gastrointestinal Nutrition and Hernia Surgery,the Second Hospital of Jilin University,Changchun 130041,China)

机构地区：[1]吉林大学第二医院胃肠营养及疝外科,长春130041

出　　处：《中华消化外科杂志》2022年第5期642-648,共7页Chinese Journal of Digestive Surgery

基　　金：吉林省财政厅卫生人才项目(2019SRCJ022);吉林大学“白求恩计划”项目(2020B02);吉林省教育厅科学技术研究项目(JJKH20211123KJ)。

摘　　要：目的探讨改良Overlap食管-管型胃(MO-EG)消化道重建在完全腹腔镜根治性近端胃切除术中的应用价值。方法采用回顾性描述性研究方法。收集2019年1月至2020年12月吉林大学第二医院收治的7例胃上部癌或食管胃结合部腺癌(AEG)行MO-EG消化道重建患者的临床病理资料;男4例,女3例;年龄为62(55~72)岁;体质量指数为21.5(18.5~26.0)kg/m^(2)。7例患者中,胃上部1/3早期癌2例,SiewertⅡ型AEG 5例。所有患者行完全腹腔镜根治性近端胃切除+D_(1)+淋巴结清扫术,术中采用倒刺线行MO-EG消化道重建。观察指标:(1)手术情况。(2)术后恢复情况。(3)术后组织病理学检查情况。(4)随访情况。采用门诊和电话方式进行随访。了解患者术后反流症状、内镜下食管反流分级、吻合口并发症及肿瘤复发、转移和生存情况。随访时间截至2021年12月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果(1)手术情况:7例患者均顺利完成完全腹腔镜根治性近端胃切除+D_(1)+淋巴结清扫术,并经腹食管裂孔入路行MO-EG消化道重建,无中转开腹手术或附加开胸手术患者;手术时间为(271±36)min,消化道重建时间为(44±10)min;术中出血量为(53±26)mL,食管游离长度为(6.4±0.3)cm。(2)术后恢复情况:7例患者术后首次下床活动时间为(21±5)h,术后首次肛门排气时间为(2.9±0.9)d,术后首次进食流质食物时间为(5.0±0.7)d,术后住院时间为(10.1±1.9)d。7例患者术后无出血、吻合口漏、死亡等严重并发症发生;1例术后出现肺部感染,经抗感染治疗后痊愈;2例术后出现胸腔积液,经保守治疗后好转。(3)术后组织病理学检查情况:7例患者肿瘤长径为(2.5±0.7)cm;上切缘组织病理学检查结果均为阴性,其中AEG食管切缘距肿瘤上缘距离为(1.8±0.6)cm;淋巴结清扫数目为(26.0±3.6)枚,下纵隔淋巴结清扫数目为(3.7±1.1)枚;病Objective To investigate the application value of modified Overlap esophago-gastric tube(MO-EG)reconstruction in totally laparoscopic radical proximal gastrectomy.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 7 patients with upper gastric cancer or adenocarcinoma of esophagogastric junction(AEG)who underwent totally laparoscopic radical proximal gastrectomy with MO-EG reconstruction in the Second Hospital of Jilin University from January 2019 to December 2020 were collected.There were 4 males and 3 females,aged 62(range,55-72)years.The body mass index of the 7 patients was 21.5(range,18.5-26.0)kg/m^(2).Of the 7 patients,2 cases had early upper third gastric cancer and 5 cases had SiewertⅡAEG.All patients underwent totally laparoscopic radical proximal gastrectomy with MO-EG recons-truction using barbed sutures.Observation indicators:(1)surgical situations;(2)postoperative recovery situations;(3)postoperative histopathological examinations;(4)follow-up.Follow-up was conducted using outpatient examination and telephone interview to detect postoperative esophageal reflux,endoscopic classification of esophageal reflux,anastomotic complications,tumor recurrence and metastasis and survival of patients up to December 2021.Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results(1)Surgical situations.All the 7 patients underwent totally laparoscopic radical proximal gastrectomy and D_(1)+lymph node dissection with MO-EG reconstruction through abdominal transhiatal approach.None of the 7 patients underwent conversion to open surgery or additional thoracotomy.The operation time,time of digestive reconstruction,volume of intraoperative blood loss and length of esophagus dissected of 7 patients were(271±36)minutes,(44±10)minutes,(53±26)mL and(6.4±0.3)cm,respec-tively.(2)Postoperative recovery situations.The time to postoperative in

关 键 词：胃肿瘤 近端胃切除术 管型胃 消化道重建 外科治疗 腹腔镜检查 

分 类 号：R735.2[医药卫生—肿瘤]