近端胃切除浆肌瓣吻合的历史及现状

History and present situation of seromuscular flap anastomosis in proximal gastrectomy

随着早期胃上部癌及食管胃结合部腺癌的检出率逐渐增高,近端胃切除术的安全性得到验证,保功能的近端胃切除术逐步得到广泛应用。然而,近端胃切除破坏了食管胃结合部的正常解剖结构,导致患者术后胃食管反流症状较重,严重影响生活质量。在各种抗反流术式中,重建"贲门-阀门"因与正常抗反流原理类似,一直是相关学者探索的热点。经过多年的发展及演进优化,目前设计的浆肌瓣吻合包括隧道式肌瓣吻合、Hatafuku设计的瓣膜成形术、单肌瓣吻合和双肌瓣吻合等。其中,双肌瓣吻合因其在临床应用中显示出良好的抗反流效果,已成为目前的研究热点。本文将对食管胃结合部抗反流的机制、食管残胃浆肌瓣吻合的历史和国内外研究现状及其热点问题进行综述。

With the increasing detection rate of early upper gastric cancer and adenocarcinoma of esophagogastric junction,the safety of proximal gastrectomy with clear indications has been verified,and function-preserving proximal gastrectomy has been widely used.However,proximal gastrectomy destructs the normal anatomical structure of esophagogastric junction,resulting in severe postoperative gastroesophageal reflux symptoms and seriously affecting the quality of life.Among various anti-reflux surgery methods,reconstruction of"cardiac valve"has always been the focus of relevant scholars because its similarity with the mechanism of normal anti-reflux.After years of development,evolution and optimization,the designed seromuscular flap anastomosis includes tunnel muscle flap anastomosis,Hatafuku valvuloplasty,single muscle flap anastomosis and double muscle flap anastomosis.The double muscle flap anastomosis has become a research hotspot because it shows good anti-reflux effect in clinical application.This paper reviews the history,research status and hot issues of seromuscular flap anastomosis of esophageal remnant stomach at home and abroad.