近端胃切除附加机械性抗反流屏障的食管胃吻合方式评价  

Evaluation of esophagogastric anastomosis with additional mechanical anti-reflux barrier after proximal gastrectomy

作　　者：高鹏 何显力 韩卓 Gao Peng;He Xianli;Han Zhuo(Department of General Surgery,Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学第二附属医院普通外科,西安710038

出　　处：《中华胃肠外科杂志》2024年第10期1018-1026,共9页Chinese Journal of Gastrointestinal Surgery

基　　金：陕西省重点产业链课题-省攻关重点项目(2022ZDLSF04-05);空军军医大学临床研究资助计划一般项目(2022LC2222)。

摘　　要：随着保功能胃切除术理念及其技术的推广,近端胃切除在适宜的胃上部癌及食管胃结合部肿瘤患者外科治疗中的应用日益增多,但术后的反流性食管炎或吻合口狭窄等问题也随之而来,已然成为学界关注的焦点。在传统食管残胃吻合基础上,基于对食管胃结合部抗反流结构与功能的充分认识,学者们成功开展了包括食管管状胃吻合、SOFY吻合以及双肌瓣技术等颇具代表性的附加抗反流机械屏障的食管残胃吻合技术,后续又衍生出一系列改良食管残胃重建方式。目前,公认的理想重建方式仍未建立,且在相关概念及认知上亦存在误区。本文结合文献和作者自身实践经验,借鉴反流性食管炎外科治疗领域的研究成果,就上述近端胃切除术后消化道重建方式的理论依据、重点细节、抗反流效果以及目前国内外的创新性手术方式,针对可能存在的问题进行剖析和探讨。The application of proximal gastrectomy for suitable upper gastric cancer and AEG patients is increasing along with the promotion of the concept and technology for function-preserving partial gastrectomy.The following problems such as postoperative reflux esophagitis and anastomotic stenosis naturally become the focus of academic field.Based on the understanding of the anti-reflux structure and function of the esophagogastric junction,scholars have successfully established some representative esophagogastric anastomosis methods with additional mechanical anti-reflux barrier,including gastric tube reconstruction,side overlap esophagogastrostomy,and double flap technique.Subsequently,a series of improved esophagogastric reconstruction methods have been derived.At present,the recognized ideal reconstruction method has not yet been established,and there are also misunderstandings in related concepts and cognition.Based on the literatures and the authors'own practical experience,this paper draws on the research results in the field of surgical treatment for reflux esophagitis,and discusses the theoretical basis,key details and anti-reflux effect of the above-mentioned digestive tract reconstruction methods after proximal gastrectomy,as well as the possible problems in the exploration of innovative surgical methods at home and abroad.

关 键 词：食管胃结合部肿瘤 近端胃切除术 消化道重建 吻合术 

分 类 号：R735[医药卫生—肿瘤]