保留胃窦的间置空肠双通道术式在食管胃结合部癌根治术中的应用探讨

目的探讨保留胃窦的间置空肠双通道术式在食管胃结合部癌(AEG)根治术中的临床应用价值。方法对66例SiewertⅡ、Ⅲ型食管胃结合部癌,分别采取保留胃窦的间置空肠双通道术式(28例)和全胃切除Roux-en-Y空肠食管吻合术式(38例),回顾性分析对比两组手术患者在手术时间、出血量、术后肠功能恢复时间以及术后并发症发生率等方面有无差异。结果保留胃窦的间置空肠双通道术式组,与全胃切除Roux-en-Y空肠食管吻合术组对比,除在术后肛门排气时间和进食流质时间两个方面略有差异外,无论在手术时间、术中出血量、住院时间以及术后早期并发症的发生率均无明显差异。此外,保留胃窦的间置空肠双通道术式组在术后的反流性食管炎发生也要低于全胃切除Roux-en-Y空肠食管吻合术组。随访6¹8个月,患者近期生活质量满意。结论保留胃窦的间置空肠双通道术式,因残胃有一定储袋作用,且进食具备双通道路径,能较好地预防反流性食管炎和倾倒综合征。同时,保留了十二指肠路径,能有效刺激胆汁分泌,降低胆结石的发生率。此外,此术式清扫、切除范围合理,手术创伤相对较小,是SiewertⅡ、Ⅲ型AEG根治术较理想的消化道重建方式之一。

Antrum preserving double tract reconstructed by jejunal interposition following radical proximal gastrectomy in adenocarcinoma of the esophagogastric junction

Objective To investigate the clinical value of antrum preserving double tract reconstructed by jejunal interposition （APDTJ） in the treatment of adenocarcinoma of the esophagogastric junction（AEG）. Methods 66 cases of Siewert Ⅱ, Ⅲ type adenocarcinoma of the esophagogastric junction were randomly divided into two groups to antrum preserving double tract reconstructed by jejunal interposition （28 cases） and total gastrectomy reconstructed by Roux-en-Y（TGRY） （38 cases）, compared two groups of surgical patients in operative time, blood loss, postoperative intestinal function recovery time and incidence of postoperative complications and so whether the differences. Results Compared with TGRY group, except postoperative intestinal function recovery time, there was no significant difference including the operative time, blood loss, hospital stay, and postoperative complications rate in APDTJ group. Furthermore, the incidence rate of postoperative reflux esophagitis in APDTJ group was less than TGRY group. Followed for 6 to 18 months, the quality of life in patients of APDTJ group was satisfactory. Conclusion APDTJ could effectively prevent the reflux esophagitis and dumping syndrome because of effect of the remnant stomach and double tract. Meanwhile, it keeps the duodenum path, could effectively stimulate the secretion of bile and reduce the incidence of gallstones. It is one of satisfactory digestive tract reconstruction methods for Siewert Ⅱ, Ⅲ type adenocarcinoma of the esophagogastric junction.