经纵隔隧道瓣成型法在腹腔镜近端胃切除术后消化道重建中的应用  

Application of hybrid transhiatal tunnel valvuloplasty following laparoscopic proximal gastrectomy

作　　者：郭春光 刘勇 屈东 任虎 李泽锋 孙崇源 张晓杰 费贺 王贵齐 赵东兵 Guo Chunguang;Liu Yong;Qu Dong;Ren Hu;Li Zefeng;Sun Chongyuan;Zhang Xiaojie;Fei He;Wang Guiqi;Zhao Dongbing(Department of Pancreatic and Gastric Surgical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Endoscopy,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100021,China;Department of Diagnostic Radiology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100021,China)

机构地区：[1]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院胰胃外科,北京100021 [2]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院内镜科,北京100021 [3]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院影像科,北京100021

出　　处：《中华普通外科杂志》2025年第1期42-46,共5页Chinese Journal of General Surgery

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-061)。

摘　　要：目的设计经纵隔隧道瓣成型法重建贲门结构,评估其在腹腔镜近端胃切除术后消化道重建中的安全性和可行性。方法选取2024年1至7月中国医学科学院北京协和医学院肿瘤医院手术治疗的11例胃上部癌患者的临床资料。手术方法:腹腔镜游离完毕,距肿瘤上缘2 cm离断食管,取出标本。距肿瘤下缘5 cm裁剪宽度4 cm、长度20 cm管型胃。距残胃顶端2 cm制作长度2 cm、宽度2 cm浆肌瓣隧道。采用Overlap杂交法重建消化道。结果本组中位手术时间175(139~285)min,中位肌瓣制作时间和重建时间分别为10.5(5.5~21.0)min和15.0(11.8~33.6)min,中位出血量50(20~100)ml,中位术后住院时间8(6~25)d,中位肿瘤大小2.5(1.0~4.0)cm,中位清扫31(15~52)枚淋巴结。术后中位随访时间3.5(0.7~6.0)个月,未见肿瘤复发转移。术后发生1例吻合口漏(Clavien-Dindo分级Ⅱ级),无围手术期死亡。全组Visick评分1分8例,2分3例,无吻合口狭窄。1例胃镜复查见反流性食管炎(洛杉矶分级B级),经药物治疗后症状缓解。结论经纵隔隧道瓣成型法手术安全性高,消化道重建难度低、抗反流效果确切。Objective To evaluate a transhiatal tunnel flap designed to reconstruct the cardiac functional structure in proximal gastric cancer patients in our center.Methods A descriptive case study method was used to select the data of 11 patients undergoing surgery for upper gastric cancer from Jan to Jul 2024.After laparoscopic dissection is completed,the esophagus is transected 2 cm from the upper edge of the tumor and the specimen is removed.The distance from the lower edge of the tumor is 5 cm.The cutting width is 4 cm,and the length of sleeve distal stump stomach is 20 cm.A seromuscular flap tunnel was made with a length of 2 cm and a width of 2 cm,2 cm away from the top of the remnant stomach.The digestive tract was reconstructed using the Overlap hybridization method.Results The median operation time was 175(139-285)minutes.The median muscle flap production time and reconstruction time was 10.5(5.5-21.0)minutes and 15.0(11.8-33.6)minutes,respectively.The median blood loss is 50(20-100)ml.The median postoperative hospitalization was 8(6-25)days.The median tumor size was 2.5(1.0-4.0)cm,and 31(15-52)lymph nodes were dissected.The median follow-up after surgery was 3.5(0.7-6.0)months,and no tumor recurrence or metastasis was found.Postoperative anastomotic leakage(Clavien-Dindo gradeⅡ)occurred in one case,and there was no perioperative death.The Visick score of the whole group was 1 point in 8 cases and 2 points in 3 cases,and there was no anastomotic stenosis.Reflux esophagitis(Los Angeles classification grade B)was found in 1 case after gastroscopy,and the symptoms were relieved by conservative treatment.Conclusion The transhiatal tunnel flap arthroplasty method has high surgical safety,low reconstruction difficulty,and an reliable anti-reflux effect.

关 键 词：胃肿瘤 胃切除术 食管胃吻合术 

分 类 号：R73[医药卫生—肿瘤]