食管胃结合部腺癌全腹腔镜经腹-左膈肌路径近端胃联合食管下段切除胸腔内Kamikawa吻合术的应用价值  

Application value of intrathoracic Kamikawa anastomosis after total laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction

作　　者：崔鹏 杨垠浩 魏伟 宗亮 宋东阳 王杰 程启升 魏晓楠 王博 胡文庆[1] Cui Peng;Yang Yinhao;Wei Wei;Zong Liang;Song Dongyang;Wang Jie;Cheng Qisheng;Wei Xiaonan;Wang Bo;Hu Wenqing(Department of Gastrointestinal Surgery,Changzhi People's Hospital Affiliated to Changzhi Medical College,Shanxi Provincial Clinical Medical Research Center for Malignant Tumor(Esophagogastric Junction Cancer),Changzhi 046099,China;Postgraduate Department of Changzhi Medical College,Changzhi 046000,China)

机构地区：[1]长治医学院附属长治市人民医院胃肠外科山西省恶性肿瘤(食管胃结合部癌)临床医学研究中心,长治046099 [2]长治医学院研究生处,长治046000

出　　处：《中华消化外科杂志》2024年第10期1309-1315,共7页Chinese Journal of Digestive Surgery

基　　金：山西省卫健委“四个一批”科技兴医创新计划项目(2022XM02);吴阶平医学基金会临床科研专项资助基金(320.6750.2020-11-6);山西省卫健委课题(2023044)。

摘　　要：目的探讨食管胃结合部腺癌全腹腔镜经腹-左膈肌路径近端胃联合食管下段切除胸腔内Kamikawa吻合术的应用价值.方法采用回顾性描述性研究方法.收集2022年4-6月长治医学院附属长治市人民医院收治的3例男性食管胃结合部腺癌患者的临床病理资料;年龄分别为69、60、66岁.患者均行全腹腔镜经腹-左膈肌路径近端胃联合食管下段切除胸腔内Kamikawa吻合术.结果(1)手术及术后情况.3例患者均顺利完成全腹腔镜经腹-左膈肌路径近端胃联合食管下段切除胸腔内Kamikawa吻合术,手术时间分别为5.3、5.3、4.8 h,消化道重建时间分别为68、62、55 min,术中出血量分别为80、30、100 mL.3例患者术后首次肛门排气时间均为术后第3天,术后首次排便时间分别为术后第4、6、3天.3例患者术后第3、7天行消化道造影检查,均未发生吻合口瘘、吻合口狭窄及造影剂反流;腹腔引流管留置时间分别为6、7、6d,胸腔引流管留置时间分别为3、5、4d,术后住院时间分别为14、14、16d.(2)术后并发症及病理学检查情况.3例患者中,术后发生Clavien-DindoⅠ级胸腔积液1例、Clavien-DindoⅠ级双侧胸腔积液1例.3例患者术后病理学检查分别为高-中分化腺癌、中分化腺癌、中分化腺癌;肿瘤最大径分别为3.0、3.5、3.5 cm;淋巴结转移/淋巴结清扫数目分别为0/43、1/34、6/44;术后病理学分期分别为T3N0M0期、T3N1M0期、T3N2M0期.(3)随访情况.3例患者术后3、12个月复查多体位上消化道造影检查均未见造影剂反流及吻合口狭窄,电子胃镜检查均未见LA-B级及以上反流性食管炎,营养指标、生命质量良好.3例患者术后12个月复查胸部+全腹部CT未见肿瘤复发或转移,可见胸腔内消化道重建后抗反流结构存在.结论食管胃结合部腺癌患者行经腹-左膈肌路径近端胃联合食管下段切除胸腔内Kamikawa吻术合安全、可行,具有良好抗反流效果.Objective To investigate the application value of intrathoracic Kamikawa anas-tomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction.Methods The retros-pective and descriptive method was conducted.The clinical data of 3 patients with adenocarcinoma of esophagogastric junction who were admitted to Changzhi People's Hospital Affiliated to Changzhi Medical College from April to June 2022 were collected.All patients were male,aged 69 years,60 years and 66 years,respectively.Patients underwent total laparoscopic proximal gastrectomy and lower esophageal resection with intrathoracic Kamikawa anastomosis through the abdominal-left diaph-ragmatic approach.Results(1)Operative and postoperative situations.All the 3 patients success-fully underwent total laparoscopic proximal stomach and lower esophagus resection with intra-thoracic Kamikawa anastomosis through the abdominal-left diaphragmatic approach.The operation time was 5.3 hours,5.3 hours and 4.8 hours,respectively.The digestive tract reconstruction time was 68 minutes,62 minutes and 55 minutes,respectively.The volume of intraoperative blood loss was 80 mL,30 mL and 100 mL,respectively.The postoperative first flatus time of 3 patients was on the third day after operation,and the first defecation time was on the postoperative fourth,sixth and third day.All the 3 patients underwent upper gastrointestinal imaging on the postoperative third and seventh day,and no anastomotic leakage,anastomotic stenosis or contrast agent reflux occurred.The indwelling time of abdominal drainage tube was 6 days,7 days and 6 days,respectively.The indwel-ling time of thoracic drainage tube was 3 days,5 days and 4 days,respectively.The duration of post-operative hospital stay was 14 days,14 days,and 16 days,respectively.(2)Postoperative complica-tions and pathological examination.Of the 3 patients,1 patient had postoperative pleural effusion of Clavien-Dindo gradeⅠ,and 1 patie

关 键 词：食管胃结合部腺癌 近端胃切除术 消化道重建 抗反流 双肌瓣吻合 

分 类 号：R735[医药卫生—肿瘤]