双通道重建在腹腔镜辅助近端胃癌根治术中的应用体会

Application of double-tract reconstruction in laparoscopic assisted proximal gastrectomy of gastric cancer

目的:总结双通道重建在腹腔镜辅助近端胃癌根治性切除术中的应用体会,评估其临床价值。方法:纳入2017年11月至2019年8月施行的57例腹腔镜辅助近端胃癌根治性切除术,术中保留远端胃,采用双通道消化道重建。观察术后双通道重建的手术结果、术后并发症、胃食管反流改善情况、术后进食情况,并行术后消化道造影,观察胃肠排空途径,术后内镜评估反流性食管炎情况。结果:57例手术均顺利完成。手术时间平均(273.7±34.3)min,双通道重建时间平均(81.9±20.4)min,手术失血量(56.1±14.3)mL。术后近期并发症发生率为12.3%,其中食管空肠吻合口漏1例,瘘口愈合后出现食管空肠吻合口狭窄。术后患者均无反酸、烧心等反流表现。术后1个月每日餐次5~7次,平均(5.8±0.8)次,此后餐次逐渐减少;术后1年,每日3次正餐外简餐1~2次,正餐餐次进食量估测为患病前的80%~90%。术后1个月行消化道造影,造影剂均经过两条通道,54例以空肠途径为主,3例以残胃十二指肠途径为主。术后1年例行胃镜检查,发现1例反流性食管炎(A级)。结论:双通道重建是较理想、安全、可行的腹腔镜辅助近端胃癌根治性切除术后的消化道重建方式,可避免术后胃食管反流,增加进食量,利于维持术后营养状态、减轻术后贫血。

Objective:To summarize the application experience of double-tract reconstruction in laparoscopic assisted proximal gastrectomy of gastric cancer and evaluate its clinical value.Methods:The clinical data of 57 patients who underwent double-tract reconstruction of the digestive tract in laparoscopic assisted proximal gastrectomy of gastric cancer from Nov.2017 to Aug.2019 were analyzed.The operation results,postoperative complications,improvement of gastroesophageal reflux and postoperative food intake were observed.Gastrointestinal emptying pathway was observed by postoperative gastrointestinal radiography,and reflux esophagitis was evaluated by postoperative endoscopy.Results:Laparoscopic assisted proximal gastrectomy with double-tract reconstruction was successfully completed in 57 cases.The operation time was(273.7±34.3)min,the double-channel reconstruction time was(81.9±20.4)min,and the blood loss was(56.1±14.3)mL.The incidence of postoperative short-term complications was 12.3%,including 1 case of esophagojejunostomy anastomotic leakage,and esophagojejunostomy stenosis occurred after the fistula healed.There was no reflux such as acid reflux and heartburn in 57 patients.One month after the operation,the average number of meals per day was(5.8±0.8)times,then the number of meals gradually decreased.One year after the operation,the number of meals per day was three meals plus one or two simple meals,and the per meal intake was estimated to be 80%-90%of the pre-disease.One month after the operation,gastroenterography was performed.The contrast medium passed two pathways in all patients,it mainly passed the jejunum in 54 cases and the remnant stomach and duodenum in 3 cases.One year after operation,gastroscopy was performed,and one case of reflux esophagitis(grade A)was found.Conclusions:Double-tract reconstruction is an ideal,safe and feasible way of digestive tract reconstruction after laparoscopic assisted proximal gastrectomy for gastric cancer.It can avoid postoperative gastroesophageal reflux,increase food intake,and help to maintain postoperative nutritional status and reduce postoperative anemia.