食管癌贲门癌切除及食管(管状胃)胃侧侧吻合术

目的探讨食管癌、贲门癌切除、食管(管状胃)胃侧侧吻合术的治疗效果及应用前景。方法共有32例患者行此手术。贲门癌6例、食管癌26例;其中胸下段9例,胸中段12例,胸上段5例。术中按肿瘤手术切除原则常规游离食管及近端胃,切除肿瘤。行主动脉弓下吻合9例,经食管床主动脉弓上吻合10例,左胸左颈两切口4例,右胸顶吻合3例,右胸颈腹三切口6例。22例患者应用管状胃代食管,10例患者应用全胃代食管。行食管胃端端吻合+侧侧吻合术15例;食管胃端侧吻合+侧侧吻合术10例;胸下段食管癌患者行食管管状胃全侧侧吻合术7例。结果本组病例术后分期分别为Ⅱa期9例,Ⅱb期11例,Ⅲ期12例。全部病例手术顺利,术后未出现吻合口瘘,术后2周复查上消化道钡透及胃镜检查均见吻合口通畅、无狭窄,术后随诊0.5～2年不等,均未见吻合口狭窄。结论食管癌、贲门癌切除食管(管状胃)胃侧侧吻合术可降低吻合口并发症尤其是狭窄的发生,值得临床推广。     

残胃食管吻合治疗贲门食管癌

自１９８３年１０月至今 ,对７例因溃疡病胃大部切除术后残胃发生贲门及食管癌患者进行了手术治疗。其中贲门癌５例 ,腹段食管癌１例 ,胸内上段食管癌１例。平均年龄６５．１岁。距胃大部切除时间平均２４．７年。首次手术均采用毕２式结肠前顺蠕动胃空肠端侧吻合 ,空肠输入输出段间未行侧侧吻合。手术方法 :经胸部左后外侧切口切开膈肌观察残胃容积平均约５００～７００ｍｌ,游离残胃及食管 ,距肿物上、下缘３～５ｃｍ处切断食管及胃体 ,切除肿瘤后残胃体积约２５０～３００ｍｌ,吻合完成后约１５０～２００ｍｌ。于靠近腹腔动脉起始部切断…     

食管癌切除颈部食管胃侧侧吻合术(附18例报告)

目的：探讨食管癌切除、颈部食管胃侧侧吻合术的治疗效果及应用前景。方法：18例中上段食管癌患者行食管癌切除、颈部食管胃侧侧吻合术，并对其临床资料进行回顾性分析术中按肿瘤手术切除原则常规游离食管及近端胃，切除肿瘤，将胃缝缩成管型；取颈部切口，暴露并游离颈段食管；根据手术切口的不同，采取不同径路将管型胃经食管床上提至颈部，将管型胃与颈段食管重叠约5cm，在胃前壁距胃底约5cm处戳一小口，将食管断端切成前长后短的斜行，将切割缝合器的钉槽插入胃内、钉仓插入食管腔，击发缝合并切割，将食管斜行断端与管型胃前壁缝合，形成长约3cm的吻合口；管型胃顶端固定于吻合口上方的颈椎前筋膜，完成颈部食管胃侧侧吻合。结果：本组病例术后分期分别为Ⅱa期（4例）、Ⅱb期（9例）、Ⅲ期（5例），手术径路分别为不开胸颈腹两切口（8例）、右胸颈腹三切口（9例）、左胸颈两切口（1例）、全部病例均手术顺利，术后出现吻合口瘘1例，发生率为5．56％，颈部引流、禁食2周后治愈；全部病例出院前复查上消化道钡透均见吻合口通畅、无狭窄，术后随诊1～5年不等，均未见吻合口狭窄，但有2例患者出现返流性食管炎症状，发生率为11．11％。结论：颈部食管胃侧侧吻合术可有效预防术后吻合口并发症的发生，值得临床推广。     

全胃切除间置空肠变法空肠代胃术20例报告

报告全胃切除间胃空肠变法空肠代胃术２０例。方法：全胃切除并淋巴结扩清后，距屈氏韧带８０ｃｍ切断空肠及其系膜，肛侧端闭锁，于１５ｃｍ行空肠侧侧吻合，于３５ｃｍ用粗丝线结扎肠管并于结扎线上下各１ｃｍ缝合浆肌层一周形成中隔，于４０ｃｍ行食管空肠端侧吻合。空肠口侧与十二指肠端端吻合。优点：１）食物通过十二指肠符合生理。２）有效地防止返流性食管炎。３）如发生吻合瘘则有利于瘘的愈合。     

胃癌全胃切除空肠间置代胃术临床评价

[目的]评价胃癌全胃切除术后连续性空肠间置代胃消化道重建术的临床应用.[方法]全胃切除后距屈氏韧带50cm处结肠后提起空肠,顶端与食管行端侧吻合(A),在A下方行空肠侧侧吻合(B),在B下方再行空肠侧侧吻合(C),在吻合口B、C降支空肠与十二指肠断端行端侧吻合(D),在D的下方降支空肠和B的下方升支空肠以7号丝线结扎.[结果]本术式有四个吻合口,借助管型吻合器吻合,不费时,手术时间平均3小时,不输血.全组36例患者均得到随访,患者均有食欲感,每日进餐4～6次,体重多恢复至术前水平或有增加,血红蛋白、血清蛋白均在正常范围,患者能从事家务及部分体力劳动,对术后生活质量感到满意.[结论]空肠间置代胃术使食物通过十二指肠符合生理;有效防止了反流性食管炎及倾倒综合征;无需切断空肠,手术省时、简捷安全,是胃癌全胃切除术后一种较为合理的消化道重建术式.     

贲门癌累及食管下段经腹经食管裂孔手术切除间置空肠重建消化道术式探讨

[目的]探讨贲门癌累及食管下段经腹手术的可行性。[方法]25例贲门腺癌,累及食管下段〈3cm,行经腹、经食管裂孔近端半胃切除间置空肠重建消化道术式,与33例贲门癌明确累及食管下段经腹完成有困难行经左胸近端半胃切除食管残胃吻合术式者对比分析。[结果]全组病例病理切缘均阴性;两组术中出血量、肿瘤根治程度比较无明显差异;经腹手术组术后吻合口瘘1例,不全肠梗阻2例,反流性食管炎1例;经左胸手术组肺部感染2例,乳糜胸1例,心血管系统并发症3例,反流性食管炎6例;经腹组心肺并发症及反流性食管炎发生率相对较低。[结论]贲门腺癌累及食管下段〈3cm行经腹手术是安全可行的。     

贲门癌经腹根治48例手术体会

贲门癌手术切口径路较多，临床选择不一。本文回顾了我们经腹手术切除４８例，现将有关体会报告如下。临床资料本组选择的病例均为发生在贲门部位或胃上部侵及贲门口附近的癌。４８例中男３４例，女１４例。年龄３６～７３岁。病理分型：腺癌３７例，粘液腺癌或低分化癌１１例。其中早期癌４例，进展期４４例。食管受累５例。切除后食管切端病理检查癌残留１例。４８例中行近侧胃大部切除４１例，全胃切除７例。切除后作食管残胃吻合４１例，食管空肠ＲｏｕＸ－Ｙ吻合６例，食管十二指肠吻合１例。手工吻合５例，器械吻合４３例。手术取上腹…     

经腹胃底贲门癌根治术47例分析

目的 探讨经腹施行胃底贲门癌根治术式。方法 对1997—2002年经腹部采用GF-1型吻合器进行食管胃吻合35例，食管空肠吻合12例进行回顾性分析。结果 根治性切除胃底贲门癌时，在切除肿瘤及其上方6～7cm食管的同时，清除纵隔下部淋巴结。全组病例无手术死亡，无吻合口瘘，亦无食管切缘癌残留，1例出现吻合口狭窄。并发症低于开胸手术。结论 经腹行胃底贲门癌根治术食管胃(空肠)机械吻合术，操作简便，术野暴露良好，创伤及生理扰乱较小，且便于扩大腹部淋巴结清除范围。     

经腹胃底贲门癌根治术47例分析

目的　探讨经腹施行胃底贲门癌根治术式。方法　对 1997— 2 0 0 2年经腹部采用GF -I型吻合器进行食管胃吻合 3 5例 ,食管空肠吻合 12例进行回顾性分析。结果　根治性切除胃底贲门癌时 ,在切除肿瘤及其上方 6～ 7cm食管的同时 ,清除纵隔下部淋巴结。全组病例无手术死亡 ,无吻合口瘘 ,亦无食管切缘癌残留 ,1例出现吻合口狭窄。并发症低于开胸手术。结论　经腹行胃底贲门癌根治术食管胃 (空肠 )机械吻合术 ,操作简便 ,术野暴露良好 ,创伤及生理扰乱较小 ,且便于扩大腹部淋巴结清除范围。     

贲门癌不同术式的选择（附胃底折叠术治疗贲门癌193例报告）

１９８７年１２月～１９９４年１２月，作者对１９３例贲门癌患者行食管、胃部分切除，食管－胃端侧吻合加胃底折叠术，与同期贲门癌手术，食管－胃端端吻合术相比较，其吻合口瘘、吻合口狭窄及返流性食管炎的发生率，前者分别为０、３．６％和６．５％，后者分别为２．５％、７．０％和１７．５％，经统计学处理，差异有显著性意义（Ｐ＜０．０１）。食管－胃端侧吻合加胃底折叠术不仅具有抗返流作用，而且吻合口瘘及吻合口狭窄发生率也低于食管－胃端端吻合术，是一种较理想的贲门癌术式。     

Proximal gastrectomy as the surgical procedure of choice for upper gastric carcinoma

To assess the efficacy of proximal gastrectomy in the treatment of upper gastric carcinoma, we analyzed clinical data from patients with lesions confined to the upper third of the stomach (group 1) and from patients with lesions which, while primarily located in the upper portion of the stomach, showed spread to the body of the stomach (group 2). Patients in group 2 showed more metastatic lymph node involvement, particularly of the infrapyloric lymph nodes, which were not included in lymphadenectomy accompanying proximal gastrectomy. None of the group 1 patients demonstrated metastasis to the infrapyloric lymph nodes. The postoperative 5-year survival rate in curatively operated group 1 patients was not significantly different between those treated by proximal gastrectomy and those subjected to total gastrectomy. We conclude that proximal gastrectomy is indicated in patients with upper gastric carcinoma when it is confined to the upper third of the stomach.     

Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction

Background. The frequency of tumors in the upper one-third of the stomach has been increasing. The standard operation for proximal gastric cancer has been total or proximal gastrectomy. The aim of this study was to present the pathologic and surgical results of 30 patients with early-stage proximal gastric cancer managed by proximal gastrectomy. Methods. A consecutive series of 30 patients who underwent proximal gastrectomy for early-stage proximal gastric cancer was studied. Sixteen patients underwent jejunal interposition, while 14 underwent gastric tube reconstruction, which consisted of a direct anastomosis between the esophagus and the remnant of the tube-like stomach. Results. Twenty patients (67%) had no abdominal symptoms and the lesions were detected by screening gastric fiberscopy. The tumors were mostly located along the lesser curvature (73%), were grossly depressed type (IIc) (70%), and histologically well differentiated type (63%). The depth of wall invasion was the mucosa in 12 patients, submucosa in 15, and muscularis propria in 3; lymph node metastasis was absent in 28 patients (93%). When compared with patients with jejunal interposition, patients with gastric tube reconstruction had a shorter operation time (327 vs 165 min), less blood loss (508 vs 151 g), and shorter hospital stay after operation (31 vs 17 days). Endoscopy and 24-h pH monitoring showed no evidence of reflux esophagitis, except in 1 patient with gastric tube reconstruction, and no patient died of recurrence. Conclusions. Early-stage proximal gastric cancer can be successfully treated by proximal gastrectomy. Since gastric tube reconstruction is a simple, easy, and safe procedure, proximal gastrectomy followed by gastric tube reconstruction is recommended for patients with early-stage proximal gastric cancer. Received for publication on Jan. 5, 1999; accepted on Feb. 10, 1999     

Quality of life and functional results following different types of resection for gastric carcinoma

In order to evaluate quality of life and functional results following surgery for gastric cancer we studied 89 patients with no evidence of disease at a minimum of 12 months postoperatively. Patients were treated with total gastrectomy and jejunal pouch reconstruction according to Hunt-Lawrence-Rodino (n = 59), distal gastric resection (n = 21) or proximal gastric resection (n = 9). No significant differences were found between total gastrectomy or distal gastric resection with respect to dumping or heartburn, while patients with proximal gastric resection suffered from both. The latter group of patients reported both reduced feelings of hunger and appetite, resulting in a reduced nutritional status. Similar differences were observed when patients were assessed for quality of life; feeling well, feeling ill and capacity to work were all reduced in patients with proximal gastric resection, and their scores were lower when scoring systems according to Visick, Karnofsky, Spitzer and Troidl were applied. Psychological-rating scales measuring complaints and distress confirmed the superiority of total gastrectomy with pouch reconstruction or distal gastrectomy compared to proximal gastric resection. We conclude that in terms of postoperative quality of life, distal gastric resection has no advantage over total gastrectomy with pouch reconstruction. Proximal gastric resection incurs bothersome sequelae and should, therefore, be avoided.     

食道-残胃吻合联合胃空肠吻合术在近端胃癌根治术中的应用

目的 探讨保留远端残胃后利用食管-残胃吻合联合胃空肠吻合术在近端胃癌根治术中的应用价值。方法 回顾性分析68例近端胃癌手术患者的临床资料，其中23例患者接受近端胃切除联合食管-残胃吻合（Esophagogastrostomy，EG组），25例患者接受全胃切除术联合食管-空肠Roux-en-Y吻合术（RY组），20例患者接受近端胃切除，利用食管-残胃吻合联合胃空肠Roux-en-Y吻合术（ Esophagogastrostomy plus gastrojejunostomy，EGJ组），分别观察三组患者的手术治疗指标、术后并发症的发生情况、术后1年的营养状态及生活质量。结果 全组病例均无围手术期死亡，三组患者术中出血量、术后近期并发症（肠梗阻、吻合口漏、吻合口出血等）差异无统计学意义(P>0．05)，EGJ组手术时间高于RY组及EG组（P﹤0.05），反流性食管炎在EG组中的发生率39.13%（9/23）明显高于RY组8%（2/25）及EGJ组5%（1/20）（P﹤0.05）。三组患者术前及术后3、6、12月体重、血红蛋白、血浆总蛋白及白蛋白水平差异均无统计学意义（P>0．05），但EGJ组患者生活质量优于其它两组（P﹤0.05）。结论 保留远端残胃后利用食管-残胃吻合联合胃空肠吻合是治疗近端胃癌安全可行，术后反流性食管炎的发生率明显降低，并可有效地提高生活质量，且操作简便，值得基层医院推广应用。     

近端胃切除术后双通道吻合的研究进展

近年来,胃癌的总体发病率和死亡率在全世界都呈现上升趋势,其中近端胃癌（包括胃上部癌和食管胃结合部癌）发病率显著升高,严重威胁人类健康。全胃切除术和近端胃切除术是目前治疗近端胃癌的主要手术方式。近端胃切除术可缩小手术范围,且能最大程度保留胃的正常功能而逐渐受到关注,但该术式术后易发生反流性食管炎,影响患者生活质量。对于近端胃切除术后消化道重建方式的选择,如何保证患者术后的生活质量,降低术后胃食管反流症状的发生率是焦点。双通道消化道重建方式作为一种具有较好的抗返流效果的术式,受到国内外众多专家学者的认可。本文将回顾近年来关于近端胃切除术后双通道消化道重建术式的研究,并对未来的发展加以展望。     

A clinicopathological study of gastric stump carcinoma following proximal gastrectomy

Background  We aimed to clarify the frequency and clinicopathological characteristics of gastric stump carcinoma following proximal gastrectomy. Methods  Three-hundred and sixteen patients who had undergone curative proximal gastrectomy over a 21-year period from January 1984 through December 2004 were reviewed. Results  Gastric stump carcinoma was observed in 17 patients (5.4%). The time interval between the initial gastrectomy and the treatment of gastric stump cancer was within 5 years in 3 patients, within 5–10 years in 8, and after 10 years in 6. Treatment included endoscopic resection (n = 4), completion total gastrectomy of the remnant stomach (n = 11), pancreatoduodenectomy (n = 1), and nonsurgical resection (n = 1). Pathologically, 9 carcinomas were differentiated and 8 were undifferentiated. In a review of reconstruction methods associated with disease stage, stage I was found in 6 of the 7 patients with esophagogastrostomy or short-segment jejunal interposition. On the other hand, stage I was found in only 3, but stage II–IV was found in 7 of the 10 patients with reconstruction by double-tract or long-segment jejunal interposition; thus, the tumor was more likely to be detected at an advanced stage after long-segment interposition (P = 0.049). Conclusion  Gastric stump carcinoma following proximal gastrectomy occurred at a high frequency of 5.4% of initial resections. It is necessary to select a reconstruction method that facilitates postoperative endoscopic examination, as well as to follow up the patients after proximal gastrectomy in the long term for the early detection and early treatment of gastric stump carcinoma.     

Growth effect of gastrin on gastric cancer and its clinical implications for gastric cancer surgery

This study was aimed at investigating the effect of gastrin on the growth of gastric cancer and evaluating postoperative hypergastrinemia in patients that had received various types of gastrectomy for gastric cancer. RT-PCR for gastrin/CCKB receptor mRNA was performed in human gastric cancer cell lines and tissue. The effect of gastrin or glycine-extended gastrin on the growth of gastric cancer cell lines was determined by MTT assay. Serum gastrin levels were compared with respect to the resection type of gastric cancer surgery. Gastrin/CCKB receptor mRNA expression was detected in all 9 gastric cancer cell lines, and in 19 of 29 (62%) gastric cancer tissue samples. Growth of gastric cancer cell lines containing the gastrin/CCKB receptor was significantly enhanced by gastrin and glycine-extended gastrin. The proximal gastrectomy group had a significantly higher mean serum gastrin level than the distal subtotal gastrectomy, total gastrectomy, or preoperative groups (p<0.05). Our study confirms that a high proportion of gastric cancer tissue samples express the gastrin/CCKB receptor, which can stimulate the growth of gastrin/CCKB receptor-positive gastric cancer cells. In addition, we confirm that hypergastrinemia can be induced in about half of patients after proximal gastrectomy. More studies are needed to clarify the relationship between hypergastrinemia and tumor recurrence after proximal gastrectomy.     

Laparoscopic-assisted versus open proximal gastrectomy with double-tract reconstruction for Siewert type II–III adenocarcinomas of esophago-gastric junction: a retrospective observational study of short-term outcomes

BackgroundCurrently, the surgical approach to adenocarcinomas of esophago-gastric junction (AEG) remains controversial. Function-preserving gastric surgeries are becoming more popular, with proximal gastrectomy with double-tract anastomosis being one of the most important for AEG. Meanwhile, with the increasing use of laparoscopic techniques in the treatment of gastric cancer, the safety and effectiveness of laparoscopic-assisted proximal gastrectomy with double-tract anastomosis for Siewert type II–III AEG need to be further clarified.MethodsData of patients with Siewert type II/III AEG was collected at our center from October 2010 to December 2019 were retrospectively analyzed. 61 patients underwent open proximal gastrectomy with double-tract anastomosis (OPG-DT group) and 52 underwent laparoscopic-assisted proximal gastrectomy with double-tract anastomosis (LAPG-DT group). The clinical features, surgery, and short-term outcomes of patients in these 2 groups were collected to assess the safety and feasibility of LAPG-DT.ResultsA total of 113 patients were analyzed, there were 98 males and 15 females. No death during the operation. The differences in the number of lymph nodes, time to first flatus time to first eating, postoperative hospital stay, Additional analgesics were not statistically significant between two groups. Although the operative duration of LAPG-DT group was significantly longer than that of the OPG-DT group [(217±61) vs. (161±14) min, P=0.000), while less blood loss and less stress in LAPG-DT group. Early and late postoperative complications were similar between two groups.ConclusionsAlthough laparoscopic-assisted proximal gastrectomy with double-tract anastomosis requires long operative time, it is associated with less bleeding and milder stress. Therefore, it is a safe and feasible surgical method.     

Selection of gastrectomy for adenocarcinomas arising in the gastric fundus

A retrospective study involving 174 patients with adenocarcinoma of the gastric fundus treated with proximal subtotal (PS), extended proximal subtotal (EPS), total (T), and extended total (ET) gastrectomy showed that 1)there were no statistically significant differences in operative mortality between the four gastrectomy types; 2)ET was associated with a significantly lower incidence of local recurrence than T (P less than 0.05) and PS (P less than 0.001); 3)ET resulted in a significantly higher survival rate than PS or T (P less than 0.01) when the three procedures were applied in patients who had TNM stage I and II tumors; 4)patients with stage III and IV tumors did poorly regardless of gastrectomy type. The study implies that intraoperative tumor staging might identify stage I and II patients who benefit the most from radical surgery and those with stage III and IV tumors who should receive palliative surgery.     

Total versus subtotal gastrectomy in cancer of the distal stomach: facts and fantasy.

The purpose of this review is to analyse critically the pros and cons of 'en principle' total gastrectomy for cancers of the distal stomach. The theoretical advantages of total gastrectomy would be the guarantee of no infiltration of the margin of proximal transection owing to multicentric cancers or to a microscopical intramural spreading of tumoral cells beyond the macroscopically detectable boundaries of the lesion. However, these expectations are not substantiated since multicentric tumours are rare, a safe margin of resection can be achieved maintaining a proximal clearance of 6 cm from the cranial edge of the tumour. Moreover, recurrences confined to the gastric stump, after subtotal gastrectomy (and originally preventable with a total gastrectomy) are extremely rare according to literature. Furthermore, current experience suggests that the extent of lymph node dissection is not affected by the extent of the resection of the stomach. Analysis of the published series of patients undergoing an en principle total gastrectomy fails to demonstrate any advantage for long-term survival compared with patients treated by subtotal gastrectomy. A recent randomized trial comparing these two procedures is in keeping with the above-mentioned conclusions. It is true, however, that the gap in surgical mortality for total and subtotal gastrectomy tends to disappear when total gastrectomy is electively performed in patients with tumours of the distal stomach. So, whereas the long-term oncological results of the two surgical procedures seem to be similar, the main disadvantage of total gastrectomy is the onset of malnutrition, which is common, but incapacitating only in a few patients. This condition is likely to be of relevance should the patients be selected for aggressive postoperative adjuvant treatments which require good general status and nutritional integrity. The main disadvantage of subtotal gastrectomy is that the patients are exposed to the risk of a gastric stump cancer. However, this risk, owing to the advanced median age of the resected patients and the actual reconstructive procedures which minimize the biliary reflux, cannot be quantified. We think that when two surgical procedures are compared, if the oncological results are the same, the operation which is associated with least discomfort and impairment of the quality of life, should be chosen.