功能性保护腹腔镜辅助根治性近端胃切除术在早期胃癌治疗中的应用

Application of laparoscopic function-preservation proximal gastrectomy in the treatment of early gastric cancer

目的探讨保留迷走神经肝支的管状胃食管侧侧吻合术在腹腔镜辅助早期胃癌近端胃切除术中应用的安全性和可行性。 方法回顾性分析2014年1月至2015年1月在上海仁济医院胃肠外科行功能性保护腹腔镜近端胃切除术的7例早期近端胃癌患者的临床资料。术中保留迷走神经肝支，并行管状胃-食管侧侧吻合进行消化道重建。 结果7例患者均成功实施腹腔镜辅助下近端胃癌根治术及保留迷走神经肝支的管状胃食管侧侧吻合术，无一例中转开腹。手术时间（213.1±22.1）min，消化道重建时间（56.9±11.6）min，术中出血量（38.6±28.1）ml。术后排气时间（2.4±0.5）d，无手术相关并发症发生，术后住院时间（9.3±0.9）d。术后7例患者均未出现严重营养不良，患者均获术后8~20（中位数14）月的随访，随访期间无一例肿瘤复发或死亡，亦未出现食管反流症状或严重反流性食管炎。 结论基于保留迷走神经肝支的管状胃食管侧侧吻合术应用于腹腔镜辅助早期近端胃癌根治术安全可行。

ObjectiveTo discuss the safety and feasibility in the preservation to hepatic branch of vagus nerve by the side-to-side tubular gastroesophageal anastomosis within the laparoscopic radical proximal gastrectomy for early gastric cancer （EGC）. MethodsRetrospective analysis on the intraoperative and postoperative data of 7 EGC patients receiving laparoscopic radical proximal gastrectomy from January 2014 to January 2015 was carried out. All the patients underwent the preservation of hepatic branch of the vagus nerve by side-to-side tubular gastroesophagreal anastomosis. ResultsAll the 7 patients completed operations successfully without conversion to open surgery. The mean operative time was （213.1±22.1）minute, the mean reconstruction time was （56.9±11.6）minute, and the mean blood loss was （38.6±28.1）ml. Postoperative time to flatus was （2.4±0.5）day, and postoperative hospital stay was （9.3±0.9）day. No operation-related complications were observed. No severe malnutrition, no recurrence or death, and no severe esophageal reflux during follow-up period were found. ConclusionThe preservation of hepatic branch of the vagus nerve by side-to-side tubular gastroesophagreal anastomosis within laparoscopic radical proximal gastrectomy for ECG is safe and feasible.