腹腔镜近端胃切除后抗反流消化道重建术式的临床评价

Anti-reflux gastrointestinal reconstruction techniques after laparoscopic proximal gastrectomy

腹腔镜近端胃切除术的应用越来越多。传统的食管残胃吻合方式会导致患者术后出现严重的反流性食管炎,影响患者生活质量。近年来,多种抗反流的腹腔镜下近端胃切除后消化道重建方式被应用到临床。笔者结合最新的临床研究结果以及自身的临床经验,对腹腔镜近端胃切除后消化道重建方式进行临床评价,重点讨论了食管胃吻合(食管胃后壁吻合、食管胃前壁吻合、管状残胃食管吻合、食管残胃侧壁吻合、双肌瓣吻合即Kamikawa吻合及改良的Kamikawa吻合等)和食管空肠吻合(间置空肠、间置空肠+储袋以及双通道吻合等),以供临床医生参考。当然,不同术式的抗反流机制不尽相同,所起到的抗反流效果参差不齐,且各术式在腔镜下完成的难度亦有所不同。因此,如何选择合理的近端胃切除后消化道重建方式,需依据患者自身的情况和医生的技术水平综合考虑。

Laparoscopic techniques are more and more poplular in proximal gastrectomy.The traditional esophagogastric anastomosis may lead to severe reflux esophagitis after surgery,affecting patient's quality of life.In recent years,multiple methods of digestive tract reconstruction after laparoscopic proximal gastrectomy capable of resisting reflux have been applied to the clinic.Combining the results of the latest clinical studies and our clinical experience,we elaborate the views on digestive tract reconstruction after laparoscopic proximal gastrectomy.Esophagogastric anastomosis(posterior esophagogastric anastomosis,anterior esophagogastric anastomosis,gastric tube reconstruction,lateral esophagogastric anastomosis,Kamikawa anastomosis and modified Kamikawa anastomosis,etc.)and esophagojejunal anastomosis(interposition jejunum,interposition jejunum with pouch,and double-channel anastomosis,etc.)are mainly discussed.Of course,the anti-reflux mechanisms of different surgical procedures are not the same,the anti-reflux effects are variable,and the surgical difficulties under laparoscopy are also different.Therefore,how to choose a rational reconstruction method after proximal gastrectomy needs to be comprehensively considered based on patient's own situation and technical level of the surgeons.