近端胃切除隧道式吻合术的可行性及疗效分析  

Efficacy and feasibility of tunnel esophagogastrostomy to perform proximal gastrectomy

作　　者：岳超 彭锐 孙广立 陈亮 汪海天 徐卫国 魏尉[1] 周斌[1] 文旭[1] 顾荣民[1] 明学志[1] 陈环球[1] 李刚[1] Yue Chao;Peng Rui;Sun Guangli;Chen Liang;Wang Haitian;Xu Weiguo;Wei Wei;Zhou Bin;Wen Xu;Gu Rongmin;Ming Xuezhi;Chen Huanqiu;Li Gang(Department of General Surgery,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院、江苏省肿瘤防治研究所、南京医科大学附属肿瘤医院普通外科,南京210009

出　　处：《中华胃肠外科杂志》2024年第10期1045-1049,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省肿瘤医院青蓝计划(2018-16);国家自然科学基金项目(82203226);江苏省肿瘤医院科技发展基金项目(ZL202101、ZJ202102);江苏省肿瘤医院优才计划(2017YYCJH-08);吴阶平医学基金(320.6750.2022-18-50)。

摘　　要：目的探讨近端胃切除术后行食管胃隧道式吻合的可行性及疗效。方法采用回顾性观察性研究方法。收集2019年10月至2022年7月期间,江苏省肿瘤医院胃外科收治的10例行近端胃切除+隧道式食管胃吻合消化道重建方式患者的临床资料;均为男性患者,年龄为(64.2±8.1)岁,体质指数为(25.5±3.2)kg/m^(2),9例为胃上部腺癌,1例为印戒细胞癌。肿瘤TNM分期显示:ⅠA期7例,ⅠB期1例,ⅡA期1例,ⅢA期1例。隧道式食管胃吻合法的主要步骤:于残胃前壁近大弯侧标记制作矩形浆肌瓣隧道(长约3 cm,宽约3.5 cm),在食管断端上缘约5 cm处与肌皮瓣上缘前后壁固定,食管残端置入隧道,手工缝合食管残端与残胃。主要观察指标为患者围手术期情况、术后反流情况(改良洛杉矶分级系统评估)以及术后1年和2年行内镜随访的结果。结果10例患者均顺利完成近端胃切除和食管胃隧道式吻合,其中4例行腹腔镜辅助手术,2例达芬奇机器人辅助手术,4例为开放手术。手术总时间为(212.7±33.2)min,吻合时间为(51.6±5.3)min,术中隧道制作时间为(20.0±3.5)min,术中出血量为(90.0±51.6)ml。术后首次排气时间为(64.8±11.5)h,术后住院时间为(9.2±1.7)d。全组仅有1例术后出现乳糜漏,均无吻合口狭窄、出血等并发症发生。术前胃食管反流病量表评分为(3.3±0.4)分,术后1个月为(3.8±1.0)分,12个月为(3.3±0.4)分。内镜随访未见明显吻合口狭窄,术后1年和2年内镜检查各见1例患者发生反流性食管炎。结论近端胃切除后行隧道式吻合消化道重建安全可行。Objective To analyze the efficacy and feasibility of performing a new surgical procedure,tunnel esophagogastrostomy,to perform proximal gastrectomy.Methods The study cohort comprised 10 consecutive patients who had undergone esophagogastrostomy by the tunnel technique in Jiangsu Cancer Hospital between October 2019 and July 2022.All patients were male.Their average age was(64.2±8.1)years and body mass index(25.5±3.2)kg/m^(2).Nine had upper gastric body adenocarcinoma,the remaining one having signet ring cell carcinoma.TNM staging of the tumors showed that seven were Stage IA,one Stage IB,one Stage IIA,and one Stage IIIA.Briefly,tunnel esophagogastrostomy is performed as follows:After performing a proximal gastrectomy,a rectangular seromuscular flap(3.0 cm×3.5 cm)is created.The posterior esophageal wall is sutured to the gastric wall at the orad end of the seromuscular flap 5 cm from the stump with three to four stitches.Next,the stump of the esophagus is opened,the posterior esophageal wall is sutured to the gastric mucosa and submucosa,and the anterior esophageal wall is sutured to the full layer of the stomach.Finally,the caudad end of the seromuscular flap is closed.Data on surgical safety,postoperative morbidity,and postoperative reflux esophagitis were analyzed.All enrolled patients completed endoscopic follow-up 1 year and 2 years after surgery.Results All procedures were completed.They comprised four cases of laparoscopic assisted surgery,four of DaVinci robotic surgery,and two of open surgery.The mean operation time was 212.7±33.2 mins,mean anastomosis time(51.6±5.3)minutes,mean tunnel preparation time(20.0±3.5)minutes,and mean operative blood loss(90.0±51.6)mL.The time to first postoperative passage of flatus was(64.8±11.5)hours.The mean hospital stay after surgery was(9.2±1.7)days.There were no postoperative complications above Clavien-Dindo Grade II.The mean preoperative Reflux Disease Questionnaire score was(3.3±0.4)before the surgery,(3.8±1.0)1 month postoperatively,and(3.3±0.4)12 months

关 键 词：胃肿瘤 近端胃切除 食管胃吻合 隧道式吻合 反流性食管炎 

分 类 号：R735.2[医药卫生—肿瘤]