近端胃切除人工三角瓣成形抗反流术的力学机理仿真分析

目的:对食管胃结合部腺癌近端胃切除术（PG）人工三角瓣成形后残胃食糜进行流体动力学数值模拟，并计算不同性质胃内食糜的流动特征。方法:构建常规PG和人工三角瓣成形术术后胃仿真模型，运用Fluent软件对不同粘度胃内食糜反流问题进行数值模拟。结果:站立位姿态时，相对常规PG方案，人工三角瓣成形手术方案表现出较好的抗反流作用；卧位姿态时，当胃内食糜粘度大于0.145 2 Pa?s，且胃内食糜不超过人工三角瓣情况下，人工三角瓣成形抗反流手术表现出较好的抗反流效果；人工三角瓣抗反流成形手术方案数值模拟结果与临床上患者表现一致。结论:本研究仿真分析为人工三角瓣成形抗反流手术方案的有效性机理分析、临床患者术后饮食及手术方案的进一步改进提供理论及数值依据。 【关键词】食管胃结合部腺癌；抗反流；人工三角瓣；计算流体力学

Simulation analysis on mechanical mechanism of proximal gastrectomy with anti-reflux anastomosis using triangle-valve technique

Abstract: Objective To carry out the fluid dynamics-based numerical simulation of gastric chyme after proximal gastrectomy with anti-reflux anastomosis using triangle-valve technique (PG-TVT) for the adenocarcinoma of the esophagogastric junction (AEG), and to further analyze the flow characteristics of different gastric chymes. Methods Based on the constructed gastric simulation models after conventional PG or PG-TVT, Fluent software was used to numerically simulate the gastric reflux with different viscosities. Results Compared with conventional PG, PG-TVT had a better anti-reflux effect in standing posture. In supine posture, when the viscosity of the gastric chyme was greater than 0.145 2 Pa?s and the stomach chyme did not exceed the artificial valve, PG-TVT could also achieve a better anti-reflux effect. Moreover, the numerical simulation results of PG-TVT were consistent with the clinical manifestations. Conclusion This simulation analysis provides a theoretical and numerical basis for the analysis on the effectiveness of PG-TVT, the postoperative diet of clinical patients and the further improvement of surgical planning.