腹腔镜辅助近端胃切除的适应证及消化道重建技巧

Indications for laparoscopy-assisted proximal gastrectomy and surgical skills of digestive tract reconstruction

近端胃切除与全胃切除相比,由于保留了胃的部分容积,对胃肠激素分泌和营养物质吸收干扰较小而具有潜在优势,被选择性地用于早期胃上部癌的治疗。腹腔镜辅助近端胃切除因考虑手术根治性和安全性等技术问题,整体而言开展并不普遍。食管-残胃吻合是近端胃切除术后最简单也是最常见的吻合方式,然而术后发生食管反流和吻合口狭窄的风险非常高。为预防近端胃切除术后反流性食管炎,外科医生开展了多种食管-空肠吻合技术,如间置空肠吻合、双通路吻合等,但是由于这些技术的复杂性,并未在腹腔镜辅助近端胃切除术中得到广泛应用。本文重点介绍腹腔镜辅助近端胃切除术中行食管-残胃吻合的一些技术要点。

Proximal gastrectomy has been applied for selected patients with early upper gastric cancer because of its potential advantages compared with total gastrectomy such as preserved gastric capacity and less interferenc e of gastrointestinal hormone and nutritional intake.However,laparoscopy-assisted proximal gastrectomy （LAPG） remains a relatively uncommon procedure because of certain technical issues,such as curability and safety.Esophagogastrostomy is the convienent and most common procedure for reconstruction after proximal gastrectomy,but it also has a high risk of postoperative reflux symptoms and anastomotic stricture.To prevent reflux esophagitis,various esophagojejunostomy techniques after proximal gastrectomy have been studied,including jejunal interposition,double tract method,etc,but these modified reconstruction methods could not be widcly applied in LAPG because of operative complexity.In this review,we focus on the operative skills and key points of esophagogastrostomy during LAPG.