近端胃切除术抗反流消化道重建方式的选择

Option of anti-reflux digestive tract reconstruction after proximal gastrectomy

世界范围内,胃上部癌及食管胃结合部癌发病率逐渐升高。目前,全胃切除术仍然是胃上部癌及食管胃结合部癌的常用手术治疗方式。然而,全胃切除术后患者不可避免出现营养代谢障碍。近端胃切除术由于保留胃部分功能,患者术后营养状况优于全胃切除术。随着早期胃癌及食管胃结合部癌检出率的提高以及研究者对淋巴结转移规律认识的深入,近端胃切除术重新引起临床医师的关注,并在临床应用中逐渐增多。然而,传统的食管胃吻合方式会引起较为严重的反流性食管炎。对此,各种抗反流消化道重建方式应运而生。笔者查阅相关文献并结合自身实践经验,就近端胃切除术抗反流消化道重建方式的研究进展进行归纳总结,为临床选择近端胃切除术消化道重建方式提供依据。

The incidence of proximal gastric cancer and esophagogastric junction cancer have increased gradually worldwide.At present,total gastrectomy is still the most commonly used method for the treatment of proximal gastric cancer and esophagogastric junction cancer.However,total gastrectomy inevitably leads to postoperative nutritional and metabolic disorders.The nutritional status of patients after proximal gastrectomy is better than that of total gastrectomy due to the preservation of partial gastric function.With the increase in the detection rates of early gastric cancer and esophagogastric junction cancer and the deepening understanding of lymph node metastasis,proximal gastrectomy has been received more attention and applied in more and more cases.Traditional esophagogastrostomy may cause severe reflux esophagitis.To overcome it,various kinds of anti-reflux digestive tract reconstructions after proximal gastrectomy have been created.Based on the relevant literature and combined with their practical experience,the authors summarize the progress in anti-reflux digestive tract reconstruction after proximal gastrectomy,in order to provide reference for choosing optimal reconstruction methods.