近端胃切除消化道重建方式的评价与选择  

Evaluation and selection of digestive tract construction procedures after proximal gastrectomy

作　　者：李晓琦 马欣俐 邱江锋[1] Xiao-Qi Li;Xin-Li Ma;Jiang-Feng Qiu(Department of Gastrointestinal Surgery,Renji Hospital,School of Medicine of Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海市200127

出　　处：《世界华人消化杂志》2024年第11期787-792,共6页World Chinese Journal of Digestology

摘　　要：近年来,随着早期胃上部癌及食管胃结合部腺癌发病率的显著增加,近端胃切除手术在保留残胃功能、改善术后营养状况的优势逐渐凸显,重新引起了临床医师的关注,并在临床应用中逐渐增多.相比全胃切除手术,近端胃切除术后反流性食管炎、吻合口狭窄的发生率较高,对患者的术后生存质量造成了一定的负面影响.因此,临床上出现了多种致力于探索近端胃切除术后抗反流的消化道重建方式以降低反流性食管炎发生率.当前,食管胃外科尚未找到一种能够适用于所有患者或能够完全避免胃食管反流的手术方式,同时又缺乏多中心大样本的高级别循证医学证据指引.如何最大化地发挥近端胃切除的优势,施行符合解剖和生理的重建术式,并尽可能降低术后反流性食管炎的发生概率,是术者在选择消化道重建方式时的一大难题.本文针对临床上最常见的5种近端胃手术方式的优缺点进行阐述,并认为当前阶段,适宜国内推广普及的消化道重建应当具备安全、简便、标准化操作性强的优点,尽早规范近端胃切除手术的技术标准,才能更好地实现手术质量控制,减少术后并发症的发生.In recent years,with the significant increase in the incidence of early upper gastric cancer and esophagogastric junction adenocarcinoma,the advantages of proximal gastrectomy in preserving residual gastric function and improving postoperative nutritional status have gradually attracted the attention of clinicians,leading to an increase in its clinical application.Compared to total gastrectomy,proximal gastrectomy is associated with a higher incidence of postoperative complications such as reflux esophagitis and anastomotic stenosis,which negatively impact the life quality of postoperative patients.As a result,various anti-reflux gastrointestinal reconstruction procedures have emerged in clinical practice to reduce the incidence of reflux esophagitis.Until now,there has been no surgical approach in esophagogastric surgery that can be applied to all patients or completely avoid gastroesophageal reflux.High-level evidence from multicenter large-sample studies is lacking to guide practice.Therefore,maximizing the advantages of proximal gastrectomy while implementing reconstructions that are anatomically and physiologically appropriate,and minimizing the occurrence of postoperative reflux esophagitis,present a significant challenge for surgeons when selecting gastrointestinal reconstruction procedures.This paper discusses the advantages and disadvantages of five most common types of proximal gastrectomy and suggests that,at this stage,suitable gastrointestinal reconstructions for promotion of proximal gastrectomy in China should be safe,simple,and highly standardized.Establishing technical standards for proximal gastrectomy as soon as possible will better ensure the control of surgical quality and reduce the incidence of postoperative complications.

关 键 词：近端胃切除 胃癌 管型胃 胃食管反流 

分 类 号：R735.2[医药卫生—肿瘤]