近端胃切除后改良肌瓣吻合术的效果分析

Analysis of the effect of modified muscle flap anastomosis after proximal gastrectomy

目的分析食管胃改良肌瓣吻合加胃间置术用于近端胃切除术的可行性及疗效。方法采用回顾性分析方法,收集2019年11月至2022年10月江苏省肿瘤医院胃外科收治的9例患者的临床资料,近端胃切除后均采用改良浆肌瓣吻合法行食管胃吻合加双通道胃间置行消化道重建。简要步骤为:于残胃前壁标记制作浆肌层隧道,长约3.0 cm,宽约3.5 cm,在食管断端上缘约5.0 cm处与肌皮瓣上缘固定,食管残端置入隧道,手工缝合食管残端与残胃,隧道吻合完成后行胃空肠吻合及空肠空肠吻合。观察患者手术安全性、围手术期并发症发生情况,术后1年内镜随访,根据改良洛杉矶分级系统评估反流性食管炎严重程度。术后1年应用EORTC QLQ-C30量表评估生活质量。结果所有病例均顺利完成手术,其中2例为腹腔镜辅助手术,7例为开放手术。手术时间为(195.2±39.8)min,吻合时间为(69.8±4.1)min,肌瓣制作时间为(21.2±3.8)min,术中失血(82.2±47.9)mL。术后通气时间为(2.6±0.7)d,总住院时间为(13.6±1.3)d。术后所有病例均无ClavienDindo分级Ⅱ级及以上并发症发生。术后1年内镜随访未见明显吻合口狭窄及反流。术后1年患者健康状况、功能量表评分较术前提高(P<0.05),症状量表评分与术前差异无统计学意义(P=0.847)。结论改良浆肌瓣食管胃吻合术浆肌瓣血供良好,能够维持良好的单向阀功能,有助于降低术后反流性食管炎发生率,改善患者术后生活质量,是一种安全可行的吻合方式。

Objective To analyze the feasibility and efficacy of using esophagogastrostric modified muscular flap anastomosis plus gastric interposition operation in proximal gastrectomy.Methods A restrospective analysis was used to collect clinical data of 9 patients admitted to the Department of Gastric Surgery of Jiangsu Cancer Hospital from November 2019 to October 2022,and esophagogastrostric modified muscular flap anastomosis plus double-channel gastric interposition of the digestive tract reconstruction were performed after proximal gastrectomy Brief steps were to make a rectangular seromuscular flap(3.0 cm×3.5 cm).in the anterior wall of the remnant stomach,fixed at about 5.0 cm above the upper edge of the esophageal stump with the upper edge of muscular flap,the esophageal stump was inserted into the tunnel,the esophageal stump and the residual stomach were manually sutured,and the gastrojejunal anastomosis and jejunovjejunostomy were performed after the tunnel anastomosis was completed.The safety of surgery and the occurrence of postoperative complications were observed,and all patients were enrolled and completed endoscopic follow-up within 1 year,and the EORTC QLQ-C30 scale was used to evaluate quality of life one year after surgery.Results All cases were completed successfluly,including 2 cases of laparoscopic assisted surgeries and 7 cases of open surgeries.The operation time was(195.2±39.8)min,the anastomosis time was(69.8±4.1)min,the modified muscular flap preparation duration was(21.2±3.8)min,and intraoperative blood loss was(82.2±47.9)mL.The total hospital stay was(13.6±1.3)d.No postoperative complication above Clavien-Dindo gradeⅡoccurred within 1 year.One year after surgery,all cases underwent endoscopic follow-up and no anastomotic stenosis or reflux esophagitis were detected.The scores of the health status and function scale were higher than those before operation(P<0.05).and there was no significant difference in the scores of symptom scale(P=0.847).Conclusions Esophagogastrostric modified muscular flap anastomosis is a safe and feasible approach for proximal gastrectomy,and the seromuscular flap has good blood supply and maintains good one-way valve function,which may have potential effectiveness in reducing the incidence of reflux esophagitis and improving the quality of life.