摘要
目的探讨腔镜辅助保留远端残胃的连续间置空肠调控性双通道重建术在食管胃结合部癌（AEG）根治术中的临床应用价值。方法对30例AEG根治术患者（SiewertⅡ型,部分SiewertⅢ型）行腹腔镜辅助D2根治性近端胃次全切除,保留远端残胃的连续间置空肠调控性双通道重建术,即不离断空肠的食管-空肠端侧吻合、残胃-空肠侧侧吻合、空肠-空肠侧侧吻合。结果 30例患者均在腹腔镜下顺利完成手术,手术时间平均（175±16）min,切缘阴性,清扫淋巴结平均（17±3）枚,无围手术期死亡、大出血、吻合口漏及狭窄梗阻发生。术后钡剂造影结果显示,大部分钡剂直接进入空肠,少部分钡剂经过残胃-十二指肠径路进入空肠,且在残胃中有延滞40-60 min,无钡剂明显反流入食管。随访6-18个月,患者无明显上腹饱胀感及反流性食管炎表现,近期生活质量满意。结论腔镜辅助保留远端残胃的连续间置空肠调控性双通道术式在AEG根治术重建中是安全可行的,操作相对简单,切除清扫范围合理;连续间置空肠,既减少离断肠管可能的污染及干扰肠蠕动,又增加了残胃储袋作用,且进食具备调控性双通道路径,能较有效的减少上腹饱胀感及反流性食管炎的发生,近期生活质量满意,是SiewertⅡ型、SiewertⅢ型AEG根治性近端胃切除术较理想的消化道重建方式,具有一定的临床推广价值。
Objective To explore the clinical evaluation of Laparoscopy-assisted distal remnant stomach-preserving regulatory double pathways reconstructed by continuous jejunal interposition in adenocarcinoma of the esophagogastric junction（ AEG） with radical operation. Methods 30 patients of SiewertⅡ、Ⅲ type（ part） of adenocarcinoma of the esophagogastric junction（ AEG） underwent laparoscopyassisted radical proximal gastrectomy and distal remnant stomach-preserving regulatory double pathways reconstructed by continuous jejunal interposition,which included continuous jejunal end-to-side esophagusjejunal anastomosis, side-to-side remnant stomach-jejunal anastomosis and side-to-side jejun-jejunal anastomosis. Results 30 cases of patients were successfully in laparoscopic surgery. Average operation time is（ 175 ± 16） min,incised margin is negative,average lymphoid nodes dissected are（ 17 ± 3）,and there are not complications such as perioperative death and bleeding,anastomotic fistula or stenosis and obstruction.Barium swallow visualization were made after operation,displaying most of Barium immediately passed the jejunum and less passed the pathway of remnant stomach-duodenum and no Barium obviously back flows esophagus. Moreover,there are 40-60 minutes in the residual stomach delay. Followed for 6 to 18 months,no obvious epigastric fullness and backstreaming esophagitis were detected and satifactory quality of life in the near future was obtained. Conclusions Laparoscopy-assisted distal remnant stomach-preserving regulatory double pathways reconstructed by continuous jejunal interposition in adenocarcinoma of the esophagogastric junction（ AEG） with radical operation is safe and feasible,and randomly complete the range of dissection and excision; Continuous jejunal interposition,which not only reduces the po llution from the pipe may heartbroken and the disturbance of intestinal peristalsis,and in crease the effect of residual stomach pouch;Regulated double channel path as eating food, can effectively reduce the epigastric fullness and backstreaming esophagitis and improve quality of life. So it is the satisifactory digestive tract reconstruction methods for SiewertⅡ,Ⅲ type adeno carcinoma of the esophagogastric junction with radical operation,and it may has certain clinical popularization value.
出处
《中华腔镜外科杂志（电子版）》
2015年第5期20-24,共5页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
关键词
食管胃结合部癌
腹腔镜
连续间置空肠
调控性双通道
消化道重建
Adenocarcinoma of the esophagogastric junction
Laparoscope
Continuous jejunal interposition
Regulated dual channel
Digestive tract reconstruction
