全腹腔镜下近端胃切除自牵引后离断技术联合双通道吻合8例

Total Laparoscopic Proximal Gastrectomy Combined With a Self-pulling and Latter Transected Method and Double Tract Anastomosis:Report of 8 Cases

目的探讨全腹腔镜下近端胃切除术后食管空肠自牵引后离断吻合技术(self-pulling and latter transection,SPLT)加残胃空肠双通道重建技术的可行性及价值。方法2019年10月~2020年10月,对5例早期食管胃结合部腺癌、2例食管胃结合部间质瘤、1例累及食管下端的胃平滑肌瘤行全腹腔镜下近端胃切除,保留远端残胃,全腹腔镜下食管空肠SPLT吻合,残胃空肠侧侧吻合、空肠空肠端侧吻合双通道消化道重建。结果手术时间(300±25)min,手术切缘阴性,5例早期胃癌清扫淋巴结15~27(20.2±4.2)枚,无吻合口漏、狭窄、梗阻等并发症。术后1个月上消化道造影显示部分造影剂可直接进入空肠,部分经过残胃十二指肠进入空肠,并在残胃中滞留30~50 min,无造影剂反流入食管。随访2~12个月,平均6个月,均无反流性食管炎表现,生活质量满意。结论腹腔镜近端胃切除SPLT加双通道吻合技术安全可行。残胃空肠双通道重建后保留部分残胃生理功能,是部分早期食管胃结合部癌及累及食管下端的食管胃结合部良性病变较理想的消化道重建方式。

Objective To investigate the feasibility and value of total laparoscopic proximal gastrectomy combined with self-pulling and latter transection(SPLT)and double tract anastomosis.Methods From October 2019 to October 2020,there were 5 patients with early-stage gastroesophageal junction adenocarcinoma,2 patients with gastroesophageal junction stromal tumors,and 1 patient with gastric leiomyoma involving the lower end of the esophagus treated with total laparoscopic proximal gastrectomy,with preserving distal remnant stomach and SPLT total laparoscopic esophagojejunostomy,side to side anastomosis of remnant stomach and end to side anastomosis of jejunojejunostomy.Results The operative time was(300±25)min,and the surgical margin was all negative.There were 15-27(20.2±4.2)lymph nodes dissected in 5 cases of early gastric cancer.No anastomotic leakage,stenosis,obstruction and other complications were found.At one month postoperatively,upper gastrointestinal contrast examination showed that part of the contrast agent could enter the jejunum directly,part of the contrast agent could enter the jejunum through the remnant gastroduodenum,and remained in the residual stomach for 30-50 minutes without contrast agent returned to the esophagus.During follow-ups for 2-12 months(mean,6 months),no symptoms of reflux esophagitis were found and the quality of life was satisfactory.Conclusions Total laparoscopic proximal gastrectomy with SPLT and double tract anastomosis is technically safe and feasible.It is an ideal way to reconstruct the digestive tract for radical resection of early gastric cancer in esophagogastric junction and for some benign lesions of the gastroesophageal junction involving the lower end of the esophagus to preserve some of the physiological functions of the residual stomach after the two-channel reconstruction of the residual stomach.