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近端胃切除是针对上部胃的早期癌的手术,比远端胃切除能够保存更多的胃功能和获得更佳的生存质量。由于切除上部胃,贲门功能丧失、胃的容积变化等所致反流性食管炎是该术式降低术后生存质量的主要原因。重建的方式多种多样,残留胃的大小决定重建方式的选择。重建时应充分注意保证安全的消化道吻合,防止胃液、肠液的食管、胃的反流,保证食物的贮存和排空功能,保存生理性通路以及保障残胃、胆、胰的内镜检查的可行性。目前,近端胃切除术后消化道重建方式中仍以食管胃吻合和间置空肠法为主体,间置空肠贮袋仍处于研究阶段。

Option and evaluation of digestive tract reconstruction after proximal gastrectomy

??Option and evaluation of digestive tract reconstruction after proximal gastrectomy HU Xiang. Department of General Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
Abstract Proximal gastrectomy is most appropriate limited surgery for early cancer of the upper stomach. Under the condition of ensuring the radical resection, proximal gastrectomy can save more function of the stomach and get a better quality of life after surgery than distal gastrectomy. For the reason of the upper gastrectomy, the gastric cardia loss of function and the gastric volume changes leading to reflux esophagitis is the main reason for reducing postoperative quality of life. Proximal stomach reconstruction is varied according to the size of the residual stomach. The reconstruction should ensure the safety of the digestive tract anastomosis, prevent the reflux of gastrointestinal fluid, ensure food storage and emptying function, preserve the food physiological pathway,and facilitate the stomach, gallbladder, pancreas endoscopy. Several reconstructive procedures after proximal gastrectomy have been reported including esophagogastrostomy, jejunal interposition and jejunal pouch interposition. The esophagogastrostomy and jejunal interposition are the best choices for their simplicity. In contrast, jejunal pouch interposition is still in the research stage.