胃上部癌手术消化道重建方式的选择

Choice of digestive tract reconstruction in upper gastric cancer

随着胃上部癌发病率的上升和早期病例的增加,选择合适的胃切除消化道重建方式逐渐被大家重视。目前,手术的安全性问题已不再是外科医生们担忧的主要问题,手术关注点逐渐转变为患者术后的生活质量。胃上部癌手术方式包括全胃切除术(TG)和近端胃切除术(PG)。TG推荐的消化道重建方式为食管空肠Roux-en-Y吻合;经典PG术后的消化道重建方式是远端残胃与食管吻合,但为了解决其引起的食管反流,多年来进行了大量探索,出现了食管管状胃吻合、双肌瓣吻合(Kamikawa吻合术)、间置空肠以及双通道吻合等重建方式。而目前何为最佳消化道重建方式,仍存在争议。本文结合文献和自身临床经验,就PG术后消化道重建方式的选择、手术难点与技巧等问题进行讨论。

With the increasing incidence of upper gastric cancer and early gastric cancer,surgeons have gradually paid attention to the selection of appropriate digestive tract reconstruction methods.At present,the safety of surgery is no longer the main aim pursued by surgeons,and the focus of surgery has gradually changed to postoperative quality of life.Surgical procedures for upper gastric cancer include total gastrectomy(TG)and proximal gastrectomy(PG).Roux-en-Y anastomosis is recommended for digestive tract reconstruction after TG.The classic method of digestive tract reconstruction after PG is distal residual stomach and esophageal anastomosis.However,to prevent esophageal reflux caused by PG,a lot of explorations have been carried out over the years,including tubular gastroesophageal anastomosis,double-flap technique(Kamikawa anastomosis),interposition jejunum,double-tract reconstruction and so on.But the appropriate method of digestive tract reconstruction for upper gastric cancer is still controversial.In this paper,based on literatures and our clinical experience,the selection,surgical difficulties and techniques of digestive tract reconstruction after PG are discussed.