腹腔镜胃上部癌根治术残胃空肠双通道重建

目的 探讨腹腔镜胃上部癌根治术残胃空肠双通道重建的价值.方法 对25例胃上部癌患者行腹腔镜近端胃大部根治性切除,保留远端残胃,行空肠残胃侧侧吻合、空肠空肠端侧吻合的双通道消化道罩=建术.结果 手术平均时间(240±35)min,切缘阴性,平均清扫淋巴结(22±5)枚,无吻合口漏及狭窄、梗阻等并发症.术后均行钡餐造影,显示大部分钡剂直接进入空肠,少部分经过残胃.十二指肠进入空肠,并在残胃中滞留30～60min,无钡剂反流入食管.随访4～18个月,患者无明显反流性食管炎表现,近期生活质量满意.结论 残胃空肠双通道重建术清扫、切除范围合理,残胃有一定储袋作用,能较好地预防反流性食管炎和倾倒综合征;保留了十二指肠径路,提高了患者生活质量,是胃上部癌根治术较理想的消化道重建方式.

Remnant stomach-jejunal dual pathways reconstruction after laparoscope-assisted radical proximal gastrectomy

Objective To investigate the value of remnant stomach-jejunal dual pathways reconstruction after laparoscope-assisted radical proximal gastrectomy in the treatment of upper gastric cancer. Methods Twenty-five patients with upper gastric cancer underwent laparoscope-assisted radical proximal gastrectomy and the remnant distal stomach was preserved for side-to-side remnant stomach-jejunal anastomosis and end-to-side jejuno-jejunal anastomosis to reconstruct dual pathways. Results The mean operation time was (240±35) minutes, the mean number of lymph nodes dissected were 22±5, and all the incised margins were negative. No anastomotic leakage, obstruction or stenosis occurred. All patients received postoperative barium meal examination. A large amount of barium directly entered the jejunum, leaving a small amount of barium entered the jejunnum via the route of remnant stomach-duodenum, and was detained in the remnant stomach for 30-60 minutes. No esophageal reflux of barium was observed. All the patients were followed up for 4-18 months, no reflux esophagitis was detected and the short-term life quality was satisfactory. Conclusions Remnant stomach-jejunal dual pathways reconstruction prevents the reflux esophagitis and dumping syndrome, preserves the pathway of duodenum and promotes the life quality of patients.