外科理论与实践

外科理论与实践 ›› 2020, Vol. 25 ›› Issue (01): 50-55.doi: 10.16139/j.1007-9610.2020.01.011

• 论著 • 上一篇    下一篇

基于浆肌双瓣技术的食管胃吻合应用于腹腔镜辅助近端胃切除术（附1例贲门部胃肠间质瘤报告并文献复习）

严超a,c,d, 陆晟a,c,d, 何相宜b, 冯润华a,c,d, 李琛a,c,d, 燕敏a,c,d(), 朱正纲a,c,d()   

  1. a.上海交通大学医学院附属瑞金医院 外科,上海 200025
    b.上海交通大学医学院附属瑞金医院 消化内科,上海 200025
    c.上海交通大学医学院附属瑞金医院 上海消化外科研究所,上海 200025
    d.上海交通大学医学院附属瑞金医院 上海市胃肿瘤重点实验室,上海 200025
  • 收稿日期:2019-12-19 出版日期:2020-01-25 发布日期:2020-02-25
  • 通讯作者: 燕敏,朱正纲 E-mail:zzg1954@hotmail.com;ym10299@163.com
  • 基金资助:
    国家自然科学基金(81772518);上海交通大学医学院多中心临床研究项目(DLY201602)

Esophagogastrostomy using seromuscular double-flap technique following laparoscopy-assisted proximal gastrectomy: a case report of gastrointestinal stromal tumor at the gastric cardia and literature review

YAN Chaoa,c,d, LU Shenga,c,d, HE Xiangyib, FENG Runhuaa,c,d, LI Chena,c,d, YAN Mina,c,d(), ZHU Zhengganga,c,d()   

  1. a. Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    b. Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    c. Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    d. Shanghai Key Laboratory of Stomach Neoplasm, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2019-12-19 Online:2020-01-25 Published:2020-02-25
  • Contact: YAN Min,ZHU Zhenggang E-mail:zzg1954@hotmail.com;ym10299@163.com

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摘要：

目的： 探讨基于浆肌双瓣技术的食管胃吻合应用于腹腔镜辅助近端胃切除术的临床疗效。方法： 回顾性分析1例于2019年9月接受腹腔镜辅助近端胃切除术的贲门部胃肠间质瘤病人的临床资料,并汇总分析浆肌双瓣技术应用于近端胃切除术后消化道重建的文献资料。结果： 本例为67岁男性病人,术前影像学检查和术后病理均诊断为贲门部胃肠道间质瘤。成功接受腹腔镜辅助近端胃切除术,消化道重建方法为基于浆肌双瓣技术的食管胃吻合。总手术时间和吻合时间分别为280 min和100 min,术中出血量为40 mL。术后首次肛门排气时间为3 d,进食流质时间为4 d,术后住院时间为8 d,无术后近期并发症发生,术后2个月内镜检查提示无反流性食管炎。文献报道显示,基于浆肌双瓣技术的食管胃吻合术后吻合口漏、吻合口出血、吻合口狭窄和反流性食管炎的发生率分别为0~4.2%、0~0.7%、4.0%~29.1%和0~8.3%。结论： 基于浆肌双瓣技术的食管胃吻合应用于腹腔镜辅助近端胃切除术,安全且可有效预防胃食管反流,可选择性应用于胃上1/3肿瘤病人,但仍需高度重视其术后吻合口狭窄的防治。

关键词: 浆肌双瓣技术, 食管胃吻合术, 腹腔镜近端胃切除术, 反流性食管炎, 胃肠间质瘤

Abstract:

Objective To investigate the clinical efficacy of esophagogastrostomy using seromuscular double-flap technique following laparoscopy-assisted proximal gastrectomy. Methods The clinical data of one patient with gastrointestinal stromal tumor at the gastric cardia who underwent laparoscopy-assisted proximal gastrectomy in September 2019 was retrospectively analyzed. We reviewed the literature about esophagogastrostomy using seromuscular double-flap technique following proximal gastrectomy and summarized the clinical data. Results This case was a 67-year-old male patient. The patient was diagnosed as gastrointestinal stromal tumor at the gastric cardia by both preoperative imaging and postoperative pathologic examination. Laparoscopy-assisted proximal gastrectomy and esophagogastrostomy using seromuscular double-flap technique was performed. The total operative time and anastomosis time were 280 min and 100 min, respectively. The intraoperative blood loss was 40 mL. The time to the first postoperative flatus was 3 d. The time to the liquid diet was 4 d. The duration of postoperative hospital stay was 8 d. No postoperative short-term complication was found. No reflux esophagitis was shown two months postoperatively with endoscopy. The literature review showed that the occurrence of anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and reflux esophagitis of esophagogastrostomy using seromuscular double-flap technique were 0-4.2%, 0-0.7%, 4.0%-29.1%, and 0-8.3%, respectively. Conclusions Esophagogastrostomy using seromuscular double-flap technique following laparoscopy-assisted proximal gastrectomy was safe and effective in terms of preventing gastroesophageal reflux. It can be applied in highly selected patient with upper-third gastric tumor. High attention is still required to prevent and treat the postoperative anastomotic stenosis.

Key words: Seromuscular double-flap technique, Esophagogastrostomy, Laparoscopic proximal gastrectomy, Reflux esophagitis, Gastrointestinal stromal tumor

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