双通道重建改良术式在早期SiewertⅡ型食管胃结合部腺癌中的应用

Modified double-tract reconstruction operation in early SiewertⅡ esophagogastric junction adenocarcinoma

目的探讨一种双通道重建改良术式─近端胃切除背驮式间置空肠单通道重建术(PJIR-STR)应用于早期SiewertⅡ型食管胃结合部腺癌(AEG)手术的安全性及术后双重抗反流效果。方法回顾性分析2018年5月至2019年10月期间山西省肿瘤医院诊断为SiewertⅡ型AEG并且行PJIR-STR 8例患者的临床资料,采用胃食管反流病问卷(GerdQ)对患者术后3、6、12、18个月的反流情况进行评分。分别于术后3、6个月时复查胃镜,采用洛杉矶分类标准对术后反流性食管炎的严重程度进行评估。结果本组8例患者术后均恢复良好,未发生严重并发症。所有患者在术后不同时间段均未见明显胃食管反流症状(GerdQ评分均<8分)。术后3、6个月复查胃镜,1例患者诊断为B级反流性食管炎,经保守治疗后好转,其余7例未见B级或以上反流性食管炎。结论PJIR-STR治疗SiewertⅡ型AEG是安全、可行的,具有良好的双重抗反流效果。

Objective To evaluate the safety and efficiency of a modified double-tract reconstruction procedure─proximal gastrectomy with piggyback interposed jejunal single-channel reconstruction(PJIR-STR)for early SiewertⅡadenocarcinoma of esophagogastric junction(AEG).Method Data of 8 SiewertⅡAEG patients at Shanxi Tumor Hospital and undergoing PJIR-STR from May 2018 to Oct 2019 were retrospectively analyzed.The gastroesophageal reflux disease questionnaire(GerdQ)was used to score the patients at 3,6,12,and 18 months after surgery.The severity of postoperative reflux esophagitis was assessed by gastroscopy at 3,6 months after surgery,using the Los Angeles Classification criteria.Result All patients recovered well after surgery without serious complications.No obvious gastroesophageal reflux was observed in all patients at different periods(All of the GerdQ scores were<8 points.)The results of gastroscopy showed that 1 patient was diagnosed as grade B reflux esophagitis at 3,6 months after surgery,which was responsive to conservative treatment,and the other 7 patients had no grade B or above reflux esophagitis.Conclusion PJIR-STR is a feasible,safe reconstruction with excellent efficiency of dual anti-reflux for the SiewertⅡAEG.