食管胃Overlap吻合联合胃体“U”型折叠用于全腹腔镜近端胃切除术的可行性和抗反流效果分析

The feasibility and anti-reflux effect of the esophagogastrostomy using overlap method combined with gastric remnant"U"shaped fold in total laparoscopic proximal gastrectomy for gastric cancer

目的 探讨食管胃Overlap吻合联合胃体“U”型折叠(EGOUF)应用于全腹腔镜近端胃切除术的可行性,并评估抗反流效果。方法 回顾性分析2023年2—12月河北医科大学第二医院胃肠外科及疝与腹壁外科收治的行全腹腔镜近端胃切除术的16例胃癌病人的临床资料,术中均采用EGOUF进行消化道重建。观察病人术中及术后情况,并对病人随访3~12个月。结果 所有病人均在全腹腔镜下完成肿瘤根治性切除和消化道重建。手术时间为(195.0±23.1)min,消化道重建时间为(60.7±7.6)min,术中失血17.5(10~50)mL,术后住院时间为9.5(8~13)d。术后无Clavien-Dindo分级Ⅰ级及以上并发症发生。所有病人均完成术后3个月随访,胃食管反流病量表(GerdQ)评分均为0分,术后无吻合口漏、吻合口狭窄、胃食管反流发生。内镜检查发现1例病人反流性食管炎洛杉矶分级为A级,吻合口食管黏膜侧局灶性红斑,其余均无反流性食管炎发生。12例病人完成术后6个月随访,GerdQ评分均为0分,未诉反酸等不适。随访远期营养指标在正常范围。4例病人完成术后1年随访,无反流性食管炎及并发症发生。所有病人肿瘤均未复发。结论 采用EGOUF进行全腹腔镜近端胃切除术消化道重建安全可行,腹壁切口小,利于病人恢复,具有良好的抗反流作用。

Objectives To investigate the feasibility and evaluate the anti-reflux effect of the esophagogastrostomy using the overlap method combined with gastric remnant"U"shaped fold(EGOUF)in total laparoscopic proximal gastrectomy for gastric cancer.Methods From February 2023 to December 2023,we retrospectively analyzed the clinical data of 16 patients with gastric cancer who underwent total laparoscopic proximal gastrectomy in the Department of Gastrointestinal,Hernia and Abdominal Wall Surgery of the Second Hospital of Hebei Medical University.The EGOUF was used to reconstruct the digestive tract in all patients.The intraoperative and postoperative conditions of all patients were observed,and the patients were followed up for 3~12 months.Results All patients underwent resection of the tumor and digestive tract reconstruction under laparoscope.The time of operation and digestive tract reconstruction were(195.0±23.1)and(60.7±7.6)minutes,respectively.The intraoperative blood loss volume was 17.5(10-50)ml,and the duration of postoperative stay in hospital was 9.5(8-13)days.No postoperative gradeⅠor above complication(Clavien Dindo)was observed.All patients were followed up for 3 months after the operation with a GerdQ scale score of 0,the patients did not complain of acid reflux,heartburn,abdominal pain,choking sensation during eating,and other symptoms.and no anastomotic stenosis or reflux was observed by the gastrointestinal angiography and gastroscopy.One patient(6.3%)was classified as LA-A(There was focal erythema on the mucosal side of the esophagus at the anastomosis),and the other patients(93.8%)had no reflux esophagitis.12 patients were followed up for 6 months after surgery,and the GerdQ score was 0.No discomfort such as acid reflux and heartburn was reported.The long-term nutritional indicators followed-up were normal.Four patients were followed up for 1 year,and no reflux esophagitis and complications occurred.None of the above patients had tumor recurrence.Conclusion Laparoscopic digestive tract reconstruction with EGOUF is safe and feasible,with the smaller incision in the abdominal wall,which is conducive to patient recovery and has a good anti-reflux effect.