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Objective:To investigate the application value of biological muscle flap in laparo-scopic radical proximal gastrectomy with esophagogastric anastomosis.Methods:The retrospec-tive and descriptive study was conducted. The clinicopathological data of 10 patients with adeno-carcinoma of esophagogastric junction who were admitted to The First Affiliated Hospital of Xi′an Jiaotong University from May 2023 to August 2023 were collected. All patients were males, aged (65±5)years. All patients underwent laparoscopic radical proximal gastrectomy and esophagogastric anastomosis with digestive tract reconstruction using the esophagogastric biological muscle flap. Observation indicators: (1) surgical situations and early complications; (2) follow-up and late com-plications. Measurement data with normal distribution were represented as Mean± SD, and measure-ment data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations and early complications. All 10 patients success-fully completed the surgery without conversion to open surgery, and the operation time was (166±18)minutes. Cases with digestive tract reconstruction as end-to-side anastomosis and Overlap anas-tomosis were 1 and 9, respectively. The time of digestive tract reconstruction, the number of lymph node dissected, volume of intraoperative blood loss, time to postoperative first anal exhaust, time to postoperative first intake of liquid food, duration of postoperative hospital stay were (40±12)minutes, 24±6, (41±9)mL, (3.4±0.5)days, (4.1±1.0)days, (8.3±0.7)days in the 10 patients. Of 4 cases with postoperative early complications, 1 case developed pulmonary infection (Clavien-Dindo grade Ⅱ) on the second day after surgery, with pulmonary infection absorbed after 5 days of antibiotic treat-ment. Two cases experienced chest distress and shortness of breath on the third day after surgery, with the diagnosis of a small to moderate amount of pleural effusion after chest B-ultrasound examination. After pleural puncture and active treatment, the symptoms of them were improved and the pleural effusion disappeared. There was 1 case with choking sensation when eating solid food, which was started from the third week after surgery. Upper gastrointestinal imaging revealed mild anastomotic stenosis of Clavien-Dindo grade Ⅰ in the patient, who was improved after conservative treatment. On the 7th day after surgery, all 10 patients underwent upper gastrointestinal angiography, and no anastomotic leakage or stenosis occurred. There was no sign of contrast agent reflux in the supine position and 30° head down position. (2) Follow-up and late complications. All 10 patients were followed up for 59.5(range, 31.0-127.0)days. The esophageal reflux scale score of 10 patients was 1.4±0.3. During the follow-up, 1 case underwent gastroscopy on 40 days after surgery, which showed reflux esophagitis with Los Angeles grade as B and the Clavien-Dindo grade as Ⅰ. There was no clinical symptom such as heartburn or acid reflux. Results of 24-hour pH monitoring showed that the patient experienced 24 instances of reflux in an upright position and 15 instances of reflux in a supine position, with no prolonged reflux. The total reflux time within 24 hours was 75 minutes. The DeMeester score was 38.3. Results of esophageal pressure measurement showed that the esophageal contraction morphology was normal, but the anastomotic opening was not well relaxed. The rest of 9 cases had no complication such as reflux esophagitis.Conclusion:Biological muscle flap applied in the laparoscopic radical proximal gastrectomy with esophagogastric anastomosis is safe and feasible, with satisfied short-term efficacy.
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Gastrointestinal reconstruction is an important step in radical gastrectomy for gastric cancer. This article reviews the digestive tract reconstruction methods of total gastrectomy, distal gastrectomy, and proximal gastrectomy, and summarizes various functional preservation gastrectomy techniques that have been continuously developed in recent years. Finally, based on the author′s relevant experience, the surgical methods designed in total gastrectomy and distal gastrectomy are introduced.
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Objective:To investigate the clinical efficacy of total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction.Methods:The data of 18 patients who underwent total laparoscopic resection of gastric stromal tumors with cosmetic suture reconstruction from December 2020 to May 2023 in Zhejiang Provincial People′s Hospital were collected retrospectively, and their clinical efficacy was analyzed.Results:Twelve patients were asymptomatic and the tumor was found during physical examination. All patients underwent total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction without conversion to open surgery. The time to resume liquid diet was 1-3(1.67±0.35)days, the postoperative hospital stay was 4-12(6.89±2.54)days, and no postoperative complications occurred. Among them, 12 cases were at low risk and 6 cases were at medium risk. CD117 and DOG-1 were positively expressed in all cases. Four out of six patients at medium risk underwent genetic testing, and two patients with c-Kit gene Lys550-Val560 mutation were treated with Gleevec therapy after surgery. Gastrography performed one month after surgery showed that the shape of the stomach was similar to the preoperative shape, with good motility and unimpeded emptying.Conclusions:Total laparoscopic resection of gastric stromal tumors combined with cosmetic suture reconstruction can reduce postoperative gastrointestinal dilatation, esophageal and pyloric stenosis, and has a certain clinical value.
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Objective:To introduce the operation process of laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction, and evaluate its feasibility, safety during perioperative period, and advantages of anastomosis.Methods:A total of 56 patients with gastric cancer who underwent laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction were selected as study subjects from Zhejiang Provincial People′s Hospital between May 2022 and June 2023. Gender, age, body mass index (BMI), tumor location, tumor stage, tumor type and other related indicators were collected. The main parameters during the operation process were collected, including operation time, anastomosis time, intraoperative blood loss, postoperative recovery status, exhaust time, feeding time, complications related to anastomosis, and length of hospital stay. The differences between other digestive tract reconstruction methods such as Overlap method, reverse puncture method, and handmade anastomosis were compared and analyzed.Results:A total of 56 patients with gastric cancer were included in this study. The anastomosis time of the tubular instrument group was (42.3±15.7)min, which was superior to the handmade anastomosis group ( P<0.05). The operation time of the tubular instrument group was (176.3±25.8)min, which was superior to other methods (all P<0.05). The intraoperative blood loss of the tubular instrument group was (75.68±20.34)ml, which was less than other methods (all P<0.05). The exhaust time of the tubular instrument group was (2.6±0.2)d, which was similar to the Overlap method ( P>0.05), but earlier than the handmade anastomosis method and the reverse puncture method (all P<0.05). The incidence of anastomotic leakage in the tubular instrument group was similar to the handmade anastomosis method, the reverse puncture method, and the Overlap method (all P>0.05). There were no significant differences in postoperative hospital stay, incision infection rate, and other complications related to anastomosis between groups (all P>0.05). Conclusions:The tubular instrument anastomosis method has a shorter operation time and a smaller incision compared to traditional laparotomy surgery. It has the advantages of laparoscopic assistance with intuitive and clear visualization during the operation, while also taking into account the convenience and safety of direct visualization under laparoscopy. It is a surgical method worthy of promotion.
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Objective:To compare the clinical efficacy and quality of life of patients between Billroth Ⅱ+ Braun anastomosis and simple Billroth Ⅱ anastomosis in digestive tract reconstruction after laparoscopic distal gastric cancer radical resection.Methods:A retrospective analysis was performed on clinical data of 68 patients who underwent laparoscopic distal gastric cancer radical resection in Jinjiang Municipal Hospital from January 2019 to January 2022. Forty patients who underwent Billroth Ⅱ+ Braun anastomosis were included in the observation group, and 28 patients who underwent simple Billroth Ⅱ anastomosis were included in the control group. Perioperative indicators and postoperative indicators one year after surgery were collected to observe the safety and efficacy of patients after surgery.Results:There were no significant differences in operation time, intraoperative bleeding volume, postoperative exhaust time, time to remove gastric tube and drainage tube, and postoperative hospital stay between the two groups (all P>0.05). There were also no significant differences in postoperative complications between the two groups ( P>0.05). One year after surgery, the incidence of food retention and residual gastritis in the observation group were lower than those in the control group (all P<0.05), while there were no significant differences in the incidence of bile reflux and reflux esophagitis between the two groups (all P>0.05). One year after surgery, nutritional evaluation showed that the total protein decline and prognostic nutritional index (PNI) in the observation group were lower than those in the control group, with significant differences (all P<0.05). The incidence of bloating and reflux symptoms in the observation group one year after surgery was lower than that in the control group, with significant differences (all P<0.05). Conclusions:Billroth Ⅱ+ Braun anastomosis is a safe method for digestive tract reconstruction after laparoscopic distal gastric cancer resection, which can improve patients′ quality of life after surgery.
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The incidence of upper gastric cancer and esophagogastric junction cancer is gradually increasing. The safety of proximal gastrectomy has been proven and widely used in clinical practice. Traditional esophageal gastric anastomosis can lead to severe reflux esophagitis after surgery, which affects patients′ quality of life. In recent years, with the continuous popularization of laparoscopy in gastric cancer radical surgery, clinicians are constantly innovating and exploring anti-reflux digestive tract reconstruction methods after proximal gastrectomy, but there is no standard consensus yet. This article reviews the research progress of anti-reflux reconstruction after laparoscopic proximal gastrectomy, combining with the latest clinical research results, aiming to provide references for colleagues and maximize patient benefits.
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Pancreatic fistula is one of the most important complications after pancreatic surgery. The International Study Group on Pancreatic Fistula proposed the definition and classification of postoperative pancreatic fistula (POPF) in 2005 firstly, which has promoted the development of pancreatic surgery research. And the International Study Group on Pancreatic Surgery modified the POPF standard in 2016 and paid more attention to clinical relevance. The POPF is often used to evaluate anastomotic methods. However, this grading version is based on clinical outcomes, which more represents the comprehensive treatment effect than reflects the quality of pancreaticojejunostomy. Using the current POPF grading criteria for the purpose of improving anastomosis methods is not very accurate, so an indicator that only reflects anastomosis′ quality is needed for the comparison of various surgical methods. To avoid the influence of non-reconstruction elements on the incidence and degree of POPF, this research team prefer the total drainage fluid amylase(DFA)or the duration of high DFA. And in this way, the comparation among different anastomotic operations could be specific and objective, which further helps to find out an ideal method for pancreatic digestive tract reconstruction.
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Objective:To explore the therapeutic experience of early postoperative hemorrhage (EPOH) from pancreaticojejunal anastomosis after pancreaticoduodenectomy (PD).Methods:A retrospective review was conducted to summarize the clinical data of a typical case of EPOH from pancreaticojejunal anastomosis after PD in Binzhou Second People′s Hospital, and the main causes and treatment of EPOH were analyzed.Results:Due to reasons such as the slender pancreatic duct, the pancreatic duct was not found after twice transections of the pancreas during the surgery. To prevent poor pancreatic fluid drainage and related complications, the pancreatic stump was not effectively sutured, and a vertical mattress suture method was used for the pancreaticojejunal anastomosis. The patient developed severe EPOH on the surgery day. Due to the fact that the digestive tract reconstruction was a biliary pancreatic separation method, the cause of EPOH was diagnosed from pancreaticojejunal anastomosis through imaging and endoscopy. After active medical treatment, the patient recovered and was discharged.Conclusion:For the treatment of pancreatic stump after PD, precise suturing should be performed on the stump while ensuring smooth pancreatic duct drainage, in order to avoid EPOH from pancreaticojejunal anastomosis to the greatest extent possible.
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The incidence of adenocarcinoma of esophagogastric junction is gradually increa-sing. The metastasis of the distal lymph node of upper gastric cancer with tumor diameter <4 cm is rare, and proximal gastrectomy can meet the requirements of radical treatment. Reflux esophagitis, food stasis, anastomotic stenosis, and poor nutrient absorption are important factors affecting the quality of life of patients undergoing proximal gastrectomy. With the continuous promotion of laparoscopic radical gastrectomy, laparoscopic proximal gastrectomy with lymph node dissection has been standardized. However, the method of digestive tract reconstruction has not yet reached standardization consensus, and anti-reflux has become a hot spot in clinical attention in recent years. Through interpositioned jejunum reconstruction to achieve anti-reflux effect, or retaining or rebuilding the anti-flow structure of esophageal residual gastric anastomosis include a variety of additional anti-reflux surgery, which have their own different advantages and disadvan-tages. The authors introduce in detail a variety of mainstream anti-reflux surgery, and its modified program, with the aim of providing reference for colleagues and maximizing the benefits of patients.
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Objective:To compare the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) assisted with colonoscope and enteroscope in patients with history of Roux-en-Y anastomosis.Methods:A retrospective study was performed on the data of 70 patients who underwent ERCP assisted with standard colonoscope or single balloon enteroscope after Roux-en-Y reconstruction in Hangzhou Hospital Affiliated to Nanjing Medical University from January 2017 to December 2020. Patients were divided into the standard colonoscopy group ( n=43) and the single balloon enteroscopy group ( n=27) according to endoscopy. The success rates of insertion, intubation and ERCP, and incidence of complications were compared. Results:A total of 81 ERCP procedures were performed in 70 patients. The insertion success rates of the standard colonoscopy group and the single balloon enteroscopy group were 91.8% (45/49) and 78.1% (25/32), respectively, showing no significant difference ( χ2=2.04, P=0.153). The success rates of primitive papilla intubation in the two groups were 74.1% (20/27) and 1/6, showing significant difference ( P=0.016). The ERCP success rates of the standard colonoscopy group and the single balloon enteroscopy group were 75.5% (37/49) and 59.4% (19/32), showing no significant difference ( χ2=2.36, P=0.124). The post operative complication incidences of the standard colonoscopy group and the single balloon enteroscopy group were 4.1% (2/49) and 9.4% (3/32), showing no significant difference ( χ2=0.25, P=0.620). Conclusion:ERCP assisted with standard colonoscope and single balloon enteroscope is safe and effective in patients after Roux-en-Y anastomosis. Standard colonoscopic ERCP can become an endoscopy solution for patients with biliary tract disease after Roux-en-Y reconstruction.
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【Objective】 Digestive tract reconstruction after total gastrectomy is complicated and causes many complications. This study aimed to investigate the feasibility, safety and effectiveness of magnetic compression anastomosis (MCA) for sutureless reconstruction after total gastrectomy in rats. 【Methods】 Twenty-four rats were randomly apportioned to two groups. Reconstruction was performed with MCA in the experimental group or hand-sewn in the control group, and the construction time was recorded. The animals were followed up for 30 days. The survival rate and complications were monitored. At each time point, the rats were euthanized to study the gross/histological morphology and mechanical strength of the anastomoses. 【Results】 The reconstruction time was (12.9±2.7)min in the experimental group and (23.8±4.1)min in the control group (P=0.036). In the experimental group, there was no anastomotic complication. Four control rats developed anastomotic leakage or hemorrhage, and all died within 4 postoperative days. Compared with the control group, burst pressure in the experimental group was similar. Both groups’ anastomoses had smooth gross appearance and histologically good alignment of tissue layers. 【Conclusion】 MCA is a safe and effective choice for reconstruction after total gastrectomy, with better postoperative outcomes than hand-sewn.
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Totally laparoscopic total gastrectomy is the most comlex procedure in gastric surgery, which involves the entire stomach removal, lymph node dissection and digestive tract recons-truction through minimally invasive techniques, among which laparoscopic esophagojejunostomy is a technological difficulty. Currently, three types of anastomoses are widely used, including stapled anastomosis with circular staplers or linear staplers, and hand suturing, but which is the best and safe anastomosis remains controversial. Based on team experience, the authors review the progress of esophagojejunostomy on stapled anastomosis or hand suturing, promote that how to select an appropriate esophagojejunostomy according to surgeon′s individual technical capabilities, operating habits and patient conditions, strive to achieve the precise and minimally invasive effect with the least trauma for patients.
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Objective:To investigate the clinical effects of totally robotic digestive tract reconstruction and modified right iliac auxiliary Trocar hole for specimen extraction in radical proctectomy.Methods:The retrospective and descriptive study was conducted. The clinical data of 139 patients with rectal cancer who were admitted to the Chongqing University Three Gorges Hospital from June 2019 to January 2022 were collected. There were 81 males and 58 females, aged (64±15)years. All patients underwent radical proctectomy with totally robotic alimentary tract reconstruction and modified right iliac auxiliary Trocar hole for specimen extraction. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Measurement data with normal distribution were represented as Mean± SD, and count data were represented as absolute numbers. Results:(1) Surgical and postoperative situations. All the 139 patients completed radical proctectomy with totally robotic alimentary tract reconstruction and modified right iliac auxiliary Trocar hole for specimen extraction successfully, without conversion to laparotomy, unplanned return to surgery or death. The length of surgical incision was (4.5±1.1)cm, operation time was (157±63)minutes, volume of intraoperative blood loss was (65±22)mL, time to postoperative first out-of-bed activities was (2.36±0.29)days, time to first flatus was (2.27±1.13)days, and time to first liquid diet was (2.90±1.12)days. The pain scores at postoperative day 1, 2, 4 were 2.34±1.07, 1.26±0.36, 0.10±0.06. The hospitalization time was (8.92±2.15)days. Results of postoperative pathological examination: the number of lymph nodes dissected was 18.1±2.3, the distal resection margin distance of tumor was (2.6±0.5)cm, and the proximal resection margin distance of tumor was (13.1±2.6)cm. The mesorectum of all specimens was intact, and the circumferential resection margin was negative. Of 139 patients, 1 case of incision fat liquefaction, 1 case of anastomotic leakage, 1 case of anastomotic bleeding, 1 case of intestinal obstruction after operation were discharged after treatment. There was no complication such as abdominal infection or hemorrhage, chylous leakage, abdominal infection. (2) Follow-up. All the 139 patients were followed up for 1 year after operation. No chronic infection of abdominal incision, incisional hernia, incisional tumor implantation, chronic incision pain, sexual dysfunction, dysuria or fecal incontinence were found during the 1-year follow-up.Conclusion:Totally robotic alimentary tract reconstruction and modified right iliac auxiliary Trocar hole for specimen extraction is safe and feasible in radical proctectomy, which has clinical application value.
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In the past few years, there has seen an increase in the detection rate of early upper gastric cancer. Early upper gastric cancer is of good prognosis. How to further enhance the postoperative quality of life of patients has increasingly become an issue of concern. This has naturally given rise to function-preserving proximal gastrectomy. However, due to its damage to the original structure of cardia and its vicinity, proximal gastrectomy is prone to postoperative reflux. To prevent postoperative reflux, various ways of digestive tract reconstruction have emerged one after another, but the optimal way thereof remains controversial. Therefore, reducing postoperative reflux through an appropriate way of digestive tract reconstruction has been taken as a focus of proximal gastrectomy. Esophagogastric anastomosis with seromuscular flap technique, as a way of digestive tract reconstruction, builds an "artificial cardia" on the basis of guarantee of normal entry of food into the digestive tract, and functions against postoperative reflux. For its good anti-reflux effect, eso-phagogastric anastomosis with seromuscular flap technique has gradually become a research focus. On top of the latest research progress at home and abroad and relevant evidence-based medicine, the authors provide on the principles, key points, improvement, postoperative status, and applica-tion of esophagogastric anastomosis with seromuscular flap technique in laparoscopic proximal gastrectomy.
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Objective:To evaluate the feasibility, safety and efficacy of uncut Roux-en-Y anastomosis, Roux-en-Y anastomosis and Billroth Ⅱ plus Braun anastomosis in laparoscopic-assisted distal gastrectomy for distal gastric cancer.Methods:In the retrospective cohort study, 71 cases of laparoscopic-assisted distal gastrectomy for distal gastric cancer from May 2016 to October 2019 in Tangshan Union Medical College Hospital were selected as the study subject. According to the different reconstruction methods of digestive tract, they were divided into: non disconnected Roux-en-Y anastomosis group (Uncut RY group, 29 cases); Roux-en-Y anastomosis group (RY group, 24 cases); Billroth Ⅱ-braun anastomosis group (B Ⅱ-Braun group, 18 cases). The operation time, digestive tract reconstruction time, intraoperative blood loss, the time to flatus, length of hospital stay, incidence of complication and the changes of nutritional index 1 year after surgery were observed. SPSS 18.0 software was used process the data, the measurement data conforming to normal distribution by Kolmogorov-Smirnov test was expressed by xˉ± s deviation, the measurement data dose not meet the normal distribution was expressed by the median (interquartile range) ( M( Q1, Q3)).Analysis of variance was used to compare the measurement data of normal distribution; Nonparametric rank sum test was used for the comparison between measurement data groups with non normal distribution; Count data were expressed in cases (%), and χ 2 test or Fisher exact probability method was used for composition comparison between groups. Results:In Uncut group, RY group and B Ⅱ-Braun group, the operation time were (196.0±28.8) min, (201.0±28.5) min and (186.4±26.1) min, respectively, the digestive tract reconstruction time were (56.2±13.9) min, (57.8±12.9) min and (51.5±10.0) min, respectively,the intraoperative blood loss were (285.2±85.4) mL, (280.1±78.4) mL and (273.3±79.6) mL, respectively, the time to flatus were (52.5±14.4) h,(53.9±14.6) h and (46.2±9.4) h, respectively, the length of hospital stay were (12.6±2.8) d, (12.1±3.0) d and (12.8±2.6) d, respectively, there were no significant differences among the three groups ( F values were 1.41, 1.33, 0.12, 1.89 and 0.35, respectively; P values were 0.251, 0.271, 0.890, 0.158 and 0.709, respectively). Postoperative complications in Uncut group, RY group and BⅡ-Braun group: The number of cases of anastomotic leakage was 0, 1 and 1, respectively. The number of cases of abdominal bleeding was 1, 1 and 0, respectively. The number of cases of bile reflux gastritis was 2, 1 and 5, respectively, and the number of cases of anastomotic ulcer was 0, 0 and 1, respectively. There were no significant differences among the three groups (Fisher's exact test, P values were 0.510,1.000, 0.063 and 0.254, respectively). The number of cases of Roux-en-Y retention syndrome was 0, 6 and 0, respectively. There were significant differences among the three groups (Fisher's exact test, P=0.001). Nutritional index: the weight loss were 4.00 (2.00, 5.50) kg, 3.00 (1.25,4.75) kg and 3.00 (1.75,4.25) kg respectively, decreases of hemoglobin level were (5.62±8.20) g/L, (6.63±6.84) g/L and(5.33±7.79) g/L, respectively, decreases of albumin level were 1.00 (-2.50, 7.00) g/L, 3.00 (-1.25, 6.75) g/L and 6.00 (-3.25,7.50) g/L, respectively. There were no significant differences among the three groups (Statistic value were χ 2=1.42, F=0.18 and χ 2=2.43, respectively, P values were 0.492,0.839 and 0.297, respectively). Conclusion:As a digestive tract reconstruction method for radical resection of distal gastric cancer, uncut Roux-en-Y anastomosis can reduce the incidence of Roux-en-Y retention syndrome without increasing the operation risk and affecting the postoperative nutritional status. It is a safe and feasible gastrointestinal tract reconstruction method.
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Objective: To explore the clinical safety and feasibility of overlapped delta-shaped anastomosis (ODA) in totally laparoscopic right hemicolectomy (TLRHC). Methods: From May 2017 to October 2019, of the 219 patients who underwent TLRHC at the Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 104 cases underwent ODA (ODA group) and 115 cases underwent conventional extracorporeal anastomosis (control group) were compared the surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications. Results: The length of the skin incision in the ODA group was significantly shorter than that in the control group [(5.6±0.9) cm vs. (7.1±1.7) cm, P<0.05], and the time to first flatus and first defecation after surgery in the ODA group was significantly earlier than that in the control group [(1.7±0.7) days vs. (2.0±0.7) days; (3.2±0.6) days vs. (3.3±0.7) days, P<0.05]. While the anastomosis time, operation time, intraoperative blood loss, the time of first ground activities, the number of bowel movements within 12 days after surgery, postoperative hospital stay, tumor size, the distal and proximal margins, the number of lymph node harvested and postoperative TNM stage in the ODA group did not differ from that of the control group (P>0.05). The postoperative complication rates of patients in the ODA group and the control group were 3.8% (4/104) and 4.3% (5/115), respectively, and the difference was not significant (P>0.05). Conclusion: The application of ODA technology in TLRHC can significantly shorten thelength of skin incisionand the recovery time of bowel function, and can obtain satisfactory short-term efficacy.
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Humains , Anastomose chirurgicale/méthodes , Colectomie/méthodes , Tumeurs du côlon/chirurgie , Études de faisabilité , Tube digestif/chirurgie , Laparoscopie/méthodes , Études rétrospectives , Résultat thérapeutiqueRÉSUMÉ
The incidence of adenocarcinoma of esophagogastric junction (AEG) is increasing in recent years. Its diagnosis, lymph node metastasis and digestive tract reconstruction are all different from those of upper gastric cancer. With the development of the concept of function preserving surgery for gastric cancer, the clinical application of laparoscopic proximal gastrectomy in AEG is increasing. In this kind of operation, in addition to ensuring sufficient radical cure of tumor, the short-term smooth recovery and long-term quality of life of patients are also important. The reconstruction of digestive tract after proximal stomach operation is of great significance. According to the author's own practical experience, in clinical work, the author selects different surgical resection scope and digestive tract reconstruction methods according to Siewert classification of AEG. For Siewert Ⅱ AEG, laparoscopic PG is mostly used, and laparoscopic esophageal tubular gastric side-to-side anastomosis or double channel anastomosis is mostly used for digestive tract reconstruction. It is believed that with the emergence of long-term follow-up results and the development of multicenter randomized controlled research, some controversial questions will be better answered. We should pay attention to the individual differences of patients. For different individuals, combined with the operator's experience, on the basis of ensuring the radical cure of tumor, we should adopt appropriate surgical resection scope and digestive tract reconstruction, so as to bring better long-term quality of life for patients.
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Humains , Adénocarcinome/chirurgie , Tumeurs de l'oesophage/chirurgie , Jonction oesogastrique/chirurgie , Gastrectomie/méthodes , Laparoscopie , Qualité de vie , Études rétrospectives , Tumeurs de l'estomac/chirurgieRÉSUMÉ
Laparoscopic techniques are more and more poplular in proximal gastrectomy. The traditional esophagogastric anastomosis may lead to severe reflux esophagitis after surgery, affecting patient's quality of life. In recent years, multiple methods of digestive tract reconstruction after laparoscopic proximal gastrectomy capable of resisting reflux have been applied to the clinic. Combining the results of the latest clinical studies and our clinical experience, we elaborate the views on digestive tract reconstruction after laparoscopic proximal gastrectomy. Esophagogastric anastomosis (posterior esophagogastric anastomosis, anterior esophagogastric anastomosis, gastric tube reconstruction, lateral esophagogastric anastomosis, Kamikawa anastomosis and modified Kamikawa anastomosis, etc.) and esophagojejunal anastomosis (interposition jejunum, interposition jejunum with pouch, and double-channel anastomosis, etc.) are mainly discussed. Of course, the anti-reflux mechanisms of different surgical procedures are not the same, the anti-reflux effects are variable, and the surgical difficulties under laparoscopy are also different. Therefore, how to choose a rational reconstruction method after proximal gastrectomy needs to be comprehensively considered based on patient's own situation and technical level of the surgeons.
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Humains , Anastomose chirurgicale/méthodes , Oesophagite peptique/chirurgie , Gastrectomie/méthodes , Jéjunum/chirurgie , Laparoscopie , Qualité de vie , Études rétrospectives , Tumeurs de l'estomac/chirurgieRÉSUMÉ
Digestive tract reconstruction is extremely important during gastric cancer surgery, which is related to long-tern quality of life of patients. The selection of reconstruction methods and the application of reconstruction techniques are major topics in the field of reconstruction-related study of gastric cancer surgery. The clinical research on digestive tract reconstruction needs to be designed and implemented scientifically to comprehensively evaluate the impact of reconstruction methods on surgical safety, long-term survival outcomes, short- and long-term changes in quality of life, endoscopic mucosal changes and postoperative nutritional status. In addition, health economic analysis is also important and should be considered in reconstruction-related studies. In brief, selection of appropriate gastrointestinal reconstruction methods based on individual characteristics of each gastric cancer patients may be an important direction of clinical trials in the future.
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Humains , Gastrectomie/méthodes , Qualité de vie , Études rétrospectives , Tumeurs de l'estomac/chirurgie , Résultat thérapeutiqueRÉSUMÉ
In the surgical treatment of adenocarcinoma of the esophagogastric junction (AEG), the scope of lymph node dissection, surgical approach selection, extent of tumor resection and digestive tract reconstruction have always been controversial, with the digestive tract reconstruction in AEG facing many challenges especially. The digestive tract reconstruction is related to the extent of resection. At present, the digestive tract reconstruction after total gastrectomy includes Roux-en-Y anastomosis, jejunum interposition and its derivatives. According to different reconstruction methods, they can be divided into tube anastomosis, linear anastomosis and manual anastomosis. Anti-reflux digestive tract reconstruction after proximal gastrectomy mainly includes esophagogastric anastomosis, interposition jejunum and double channel anastomosis. At present, double channel anastomosis is the most common reconstruction method in China. Based on the concept of interposition tubular stomach and reconstruction of gastric angle for anti-reflux, we propose "Giraffe" anastomosis, which moves artificial fundus and His angle downward to retain more residual stomach, showing good gastric emptying and anti-reflux effect. In this paper, combined with our clinical experience and understanding, we discuss the selection and technical key points of digestive tract reconstruction methods in AEG, and suggest that composite anti-reflux mechanism design may be the development trend of anti-reflux reconstruction in the future. The composite mechanism includes the retention of gastric electrical pacemaker in greater curvature of the middle part of gastric body to increase the emptying capacity of residual stomach, the reconstruction of gastric fundus and His angle anti-reflux barrier, and the establishment of an interposition tubular stomach acting as a buffer zone in Giraffe construction, and so on.