食管胃结合部癌的消化道重建

Digestive tract reconstruction for carcinoma of the esopha-gogastric junction

近端胃大部切除术后食管残胃吻合是常用的术式，但是由于手术破坏了防反流结构，造成残胃内容物反流至食管内导致反流性食管炎。管状胃消化道重建，采取食管残胃前壁吻合及幽门成型可以在残胃残端形成类似胃底结构，防反流作用明显，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，连续间置空肠具有操作简便、安全可靠等优点。天津医科大学肿瘤医院对1例食管胃结合部腺癌和1例食管胃结合部间质瘤患者实施近端胃切除术，术后分别采取了管状胃食管吻合和连续间置空肠两种消化道重建方式。患者术后恢复顺利，无相关}肖化道并发症发生。

Esophagogastric end-to-end anastomosis is the most common method for digestive tract reconstruction after proximal subtotal gastrectomy, while patients often suffered from postoperative reflux esophagitis due to the injury of the anti-re- flux structure. Tubular stomach with esophagogastric anterior wall end-to-side anastomosis combined with phloroplasty reduces postoperative gastroesophageal reflux because it functions for food storage and digestion. Jejunal interposition can effectively prevent gastroesophageal reflux, and continual jejunal interposi- tion has advantages of convenience and safety. One patient with gastric adenocarcinoma and 1 with gastric stromal tumor received proximal subtotal gastrectomy at the Cancer Hospital of Tianjin Medical University. Tubular stomach and continual jejunal inter- position were applied after gastrectomy. The 2 patients recovered uneventfully, no digestive complications were detected.