近端胃切除抗反流消化道重建方式的研究进展

doi:10.16139/j.1007-9610.2023.04.017

摘要/Abstract

摘要：

近端胃癌在中国及部分亚洲国家的发病率呈逐年上升趋势。手术是该疾病最有效、最常用的治疗方式。传统全胃切除术具有较好的根治效果，但术后难以避免营养代谢障碍、生活质量下降等并发症发生。近年来临床开展的近端胃切除术在切除肿瘤组织的同时，保留部分胃组织，有利于改善病人术后营养状况。然而近端胃切除术中破坏食管括约肌和His角，引起残胃反酸、反流，导致反流性食管炎，同样也影响病人的生活质量。为解决反流的问题，临床医师探索不同消化道重建术式，目前有报道的消化道重建方法很多，各有优劣。本文结合相关文献和临床新进展，列举目前常用消化道重建方法，总结其术后生活质量、生存结局相关文献资料，以供临床医师参考和选择。

关键词: 近端胃癌, 近端胃切除术, 反流性食管炎, 消化道重建

Abstract:

The incidence rate of proximal gastric cancer in China and some Asian countries is increasing year by year. Surgery is the most effective and commonly used treatment for proximal gastric cancer. Traditional total gastrectomy has a good curative effect, but its complications, such as dystrophic metabolism and decreased quality of life, limited its use. In recent years, the proximal gastrectomy carried out clinically can remove tumor tissue and preserve part of gastric tissue, which is conducive to improving the postoperative nutritional status of patients. However, during proximal gastrectomy, the esophageal sphincter and His angle were damaged, resulting in residual gastric acid reflux and gastroesophageal reflux, resulting in reflux esophagitis, which also affected the quality of life of the patients. In order to solve these problems, surgeons have explored different digestive tract reconstruction methods. So far, many digestive tract reconstruction methods have been reported. This paper introduced the commonly used digestive tract reconstruction methods, and summarized the literature on postoperative quality of life and survival outcomes, so as to provide reference and choice for surgeons.

Key words: Proximal gastric cancer, Proximal gastrectomy, Reflux esophagitis, Digestive tract reconstruction

中图分类号:

R735.2
R571

孙强, 姚骏, 张鑫, 杜杉珊, 王伟军. 近端胃切除抗反流消化道重建方式的研究进展[J]. 外科理论与实践, 2023, 28(04): 388-393.

SUN Qiang, YAO Jun, ZHANG Xin, DU Shanshan, WANG Weijun. Research progress of anti reflux digestive tract reconstruction for proximal gastrectomy[J]. Journal of Surgery Concepts & Practice, 2023, 28(04): 388-393.

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参考文献 29

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Author	Type of anastomosis	Number of anastomoses	Patients (male/female)	Reflux esophagitis [n（%）]
Nakamura, et al^[10]	Traditional EG	1	64(49/15)	15/55(27.3)
Yamasaki, et al^[5]	Tube-like stomach EG	1	115(88/27)	20/115(17.4)
Tsumura, et al^[6]	DFT	1	19(16/3)	0
Yamashita, et al^[19]	SOFY	1	14(11/3)	1/10(10.0)
Nomura, et al^[7]	JI	3	15(11/4)	1/156.7)
Yamasaki, et al^[5]			34(22/12)	3/34 (8.8)
Nakamura, et al^[10]	JPI	3	12(9/3)	2/12 (16.7)
Hong, et al^[23]	DTR	3	21(16/5)	0
Ji, et al^[22]			25(24/1)	2/25(8.0)
Nomura, et al^[7]			15(13/2)	1/15 (6.7)
Nomura, et al^[29]	Modified-DTR	3	10(7/3)	1/10 (10.0)
Nomura, et al^[7]			15(11/4)	1/15 (6.7)

Author	Year	Surgical method	Sex (male/female)	Average weight recovery (%)	Increased hemoglobin (g/L)	Increased albumin (g/L)	Average food intake recovery (%)
Ichikawa, et al^[3]	2014	TG	29/6	85.3	29.7±5.4	15.7±3.6	93.4
		PG	34/15	90.2^a)	42.5±6.7^a)	20.8±3.2^a)	99.1^a)
Yamasaki, et al^[5]	2020	TG	67/26	86.2	30.5±5.9	16.4±3.8	92.5
		PG	116/43	88.9	44.8±6.2^a)	19.8±4.1^a)	98.4^a)
Masuzawa, et al^[4]	2014	TG	89/33	87.9	27.4±5.3	15.5±3.2	94.8
		PG-EG	36/13	91.6	47.1±5.9^a)	20.1±3.8^a)	99.2^a)
Tsumura, et al^[6]	2020	TG	11/6	86.5	28.4±4.7	17.4±4.2	93.7
		PG	16/3	89.4	40.8±5.4^a)	20.9±4.3^a)	98.9^a)