开放胃癌全胃切除消化道重建术式的选择与评价

Selection and assessment of digestive tract reconstruction methods after total gastrectomy for gastric cancer

近年来,胃癌全胃切除术的应用日益增多,而全胃切除术后消化道重建始终是胃肠外科领域备受关注和最富争议的话题。全胃切除术后的消化道重建术式繁多,文献报道多达70余种。不同术式的优劣性,众说纷纭,但迄今仍无一种真正理想而广为接受的消化道重建术式。如何在保证肿瘤学和手术学安全性的同时,提高患者术后生活质量成为争议的核心;而其中的焦点问题主要围绕以下三方面:(1)维持十二指肠生理性通道是否必要?(2)是否需要构建代胃袋?(3)哪种代胃袋最为理想?这些争议的解决,仍将有赖于大样本、多中心、前瞻性、随机对照临床研究所提供的循证医学证据。

Total gastrectomy has been performed increasingly for gastric cancer in recent years.However,it remains controversial over the optimal models for digestive tract reconstruction after total gastrectomy.Up to now,more than 70 types of digestive tract reconstruction methods after total gastrectomy have been reported.Every procedure has its merits and demerits,and no ideal digestive tract reconstruction is available for all conditions.The controversies include how to improve the postoperative quality of life of patients in terms of oncological and operative safety,including （1） the necessity of physiological duodenal passage; （2） the necessity of construction of gastric substitution; and （3） the optimal type of gastric sulbstitution.The definitive conclusions require more and more evidences obtained from large sample,multicenter,and prospective randomized control trials.