“衣领”式残胃折叠术在腹腔镜近端胃癌根治术后消化道重建中的初探讨及效果分析

The clinical application effect of"collar"fundoplication in patients with laparoscopic proximal radical gastrectomy

目的:探讨“衣领”式残胃折叠术在腹腔镜近端胃癌根治术后消化道重建中的应用及其抗反流效果。方法:分析2022年5~8月为6例近端胃癌患者行腹腔镜近端胃癌根治术的临床资料,并对消化道重建方式进行改进,即在食管残胃吻合后再行“衣领”式残胃折叠术,以起到抗食管反流的目的。术后通过患者主观症状、上消化道钡餐及胃镜检查评定抗反流效果。结果:6例患者均完成腹腔镜下近端胃癌根治术并成功行“衣领”式残胃折叠术,术后无手术死亡病例及吻合口漏、吻合口狭窄发生。1例患者自觉轻度反流,口服质子泵抑制剂后控制良好,余者均无反流、烧心等症状。1个月后行上消化道造影检查,直立位均无反流发生,胃镜检查见吻合口愈合良好,无溃疡及糜烂发生。结论:“衣领”式残胃折叠术在腹腔镜近端胃癌根治术后具有很好的抗反流作用,但还需要更多的病例及长期随访进一步验证。

Objective:To explore the clinical application effect of“collar”fundoplication in reconstruction of digestive tract a fter laparoscopic proximal radical gastrectomy and its anti-reflux effect.Methods:Clinical data of six patients with proximal gastric cancer who underwent laparoscopic proximal radical gastrectomy from May 2022 to Aug.2022 were analyzed,a new improved fundoplication named“collar”fundoplication was used in the procedure for anti-esophageal reflux.Subjective symptoms were recorded and u pper gastrointestinal barium meal and gastroscopy were performed to every patient.Results:All patients were performed laparoscopic proximal radical gastrectomy and“collar”fundoplication successfully.No postoperative death,anastomotic leakage and anastomotic s tenosi s occurred.One patient felt mild reflux that was well controlled by oral medication with proton pump inhibitors,while the other patients felt no reflux symptoms.One month later,upper digestive tract radiography indicated no reflux to the esophagus of the contrast medium in orthostatism,and gastroscopy showed no ulcer or erosion of the anastomosis.Conclusions:“Collar”fundoplication in l aparoscopic proximal radical gastrectomy may be a promising procedure for reflux esophagitis prevention.However,more patients and long-term follow-up are required to show benefits of this new procedure.