食管胃结合部腺癌消化道重建方式选择及评价

Choices and evaluation of digestive tract reconstructive procedures for patients with adenocarcinoma of the esophagogastric junction

近端胃大部切除仅适于T1N0期食管胃结合部腺癌(AEG),近端胃大部切除后食管-残胃吻合是最常用的术式,但是由于破坏了防反流结构,造成残胃内容物反流至食管内导致反流性食管炎。食管-残胃前壁吻合可以在残胃残端形成类似胃底结构,形成HIS角,防反流作用明显。采取食管与胃黏膜单层套入式吻合也可以达到防止反流的效果。管状胃基本保持了胃的解剖结构,具备食物的贮存与消化功能。间置空肠可以有效防止反流,空肠储袋间置增加了残胃容量。双通路加近口端储袋可以延缓食物进入十二指肠的时间。

Proximal gastrectomy is adequate only for early gastric cancer located in the upper third of stomach. Patient with reconstruction by esophagogastric end-to-end anastomosis suffers postoperative reflux symptoms and esophagitis. Patient with esophagogastric anterior wall end-to-side anastomosis combined with pylorplasty showes good postoperative quality of life such as recovery of body weight, less discomfort after meals and less heart burn or belching. Gastric tube reconstruction reduces postoperative gastroesophageal reflux since it functions for food storage and digestion although it is small. Jejunal interposition reconstruction maybe a good candidate for reconstructive surgery and a jejunal pouch interposition can increase the volume of remaining stomach. The advantage of double tract reconstruction may be demonstrated when a jejunal pouch to the oral side of the duodenum is added.