胃癌根治术后消化道重建的原则与进展

Reconstruction of the digestive tract after radical resection of gastric cancer: principles and progress

胃癌根治术后消化道重建方式种类繁多,但是消化道重建基本原则是一致的。操作简便、保证手术安全、术后功能良好和便于复查的消化道重建方式是最理想的目标。在此,本文章对胃癌根治手术后常用的重建方式做一概述。远端胃大部切除术后,毕Ⅱ式或Roux-en-Y吻合重建术适应证较广,并发症少,肿瘤复发率低。而毕Ⅰ式重建方式在有限的范围内实用也可以起到良好的效果。全胃切除术后,行食管空肠Roux-en-Y重建,手术操作简便、吻合口少,并且术后并发症发生率低,同时患者的术后生活质量较满意。对进展期胃癌和病期相对较晚、预后相对较差的胃癌患者,我们推荐行食管空肠Roux-en-Y吻合;而对于早期胃癌患者,考虑到患者生存期较长,可以考虑在Roux-en-Y重建基础上加做贮袋,来提高患者术后生活质量;近端胃癌行近端胃大部切除术后的重建方式,建议采用食管残胃吻合,此法简单实用,值得推广。

Although lots of reconstruction methods are available after radical surgery for gastric cancer,the basic principles of reconstruction have never changed.Convenience,safety,clinical outcome and feasibility of reexamination are always the key points of gastrointestinal reconstruction.This review focases on the methods of reconstruction after radical gastrectomy.Billroth Ⅱ and Roux-en-Y anastomosis are commonly used reconstruction methods with less postoperative complications and lower rate of cancer recurrence after distal gastrectomy,while Billroth Ⅰ anastomosis showing limited indications and satisfactory outcomes.After total gastrectomy,Roux-en-Y anastomosis of the esophagus and jejunum is convenient,with less stoma,lower rate of postoperative complications and satisfactory quality of life.For advanced stage or poor prognosis of gastric cancers,Roux-en-Y anastomosis is recommended,whereas additional jejunal reservoir could improve postoperative quality of life for patients with early-stage gastric cancer.After proximal gastrectomy,esophagogastric anastomosis is convienent and is worth popularizing.