摘要
目的介绍食管残胃全腔镜下改良单肌瓣成形术——斜角吻合加单肌瓣成形术(oblique anastomosis plus single flap valvuloplasty,OSF)的技术要点及其在食管胃结合部癌手术中的应用情况。方法2022年1月至2025年1月中国医学科学院北京协和医学院肿瘤医院深圳医院胃肠外科对20例SiewertⅡ型食管胃结合部癌患者开展了OSF。主要步骤如下:①近端胃切除及淋巴结清扫;②制作残胃单肌瓣;③食管残胃吻合;④缝合单肌瓣。回顾性分析患者的基线资料、围手术期结局及术后随访结果。结果行OSF的患者中,男性12例,女性8例,平均年龄(68.2±6.8)岁,体重指数为(21.88±6.20)kg/m^(2),肿瘤长径为(2.2±0.4)cm。20例患者均顺利完成OSF重建。中位手术时间255(225~428)min,中位重建时间112(76~140)min,中位失血量50(20~400)ml。术后病理分期为Ⅰ期的有12例,Ⅱ~Ⅲ期有8例。术后中位进食时间为4(4~6)d,术后中位住院时间为7(6~10)d。术后早期并发症包括3例肺炎、1例胆囊炎,均经保守治疗后好转。术后6周出现1例吻合口狭窄,内镜下扩张3次后恢复正常进食。术后1年复查时,20例患者均未出现B级及以上反流性食管炎,所有患者均不需服用抗反流药物。体重减轻>10%为2例。结论OSF是一种具有良好抗反流效果的、安全的食管残胃重建方法。
Objective To introduce the technical key points of the totally laparoscopic modified single flap valvuloplasty for the esophago-remnant gastric—oblique anastomosis plus single flap valvuloplasty(OSF)—and its application in surgeries for esophagogastric junction(EGJ)cancer.Method From January 2022 to January 2025,20 patients with Siewert typeⅡEGJ cancer undergoing laparoscopic proximal gastrectomy underwent reconstruction using the OSF technique in the Department of Gastrointestinal Surgery at Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College.The surgical steps were as follows:①proximal gastrectomy and lymph node dissection;②creation of a single flap of the remnant stomach;③esophago-gastric anastomosis;④suturing of the single flap.A retrospective analysis was conducted on the baseline characteristics,perioperative outcomes,and postoperative follow-up data of these 20 patients.Result Among the patients who underwent OSF reconstruction,12 were males and 8 were females,with an average age of(68.2±6.8)years,an average body mass index of(21.88±6.20)kg/m^(2),and an average tumor diameter of(2.2±0.4)cm.The median operation time was 255(225-428)minutes,the median reconstruction time was 112(76-140)minutes,and the median blood loss was 50(20-400)ml.Pathological staging revealed stageⅠin 12 patients and stageⅡ-Ⅲin 8 patients.The median time to start oral intake was 4(4-6)days,and the median postoperative hospital stay was 7(6-10)days.Early postoperative complications included 3 cases of pneumonia and 1 case of cholecystitis,all improved with conservative management.6 weeks after the operation,1 case of anastomotic stenosis occurred.After 3 times of endoscopic dilation,the patient resumed normal eating.At the 1-year endoscopic follow-up,no patient exhibited reflux esophagitis of Grade B or higher,and none required anti-reflux medication.Weight loss exceeding 10%was observed in 2 patients.Conclusion The OSF technique is a safe and effective reconstruction method following proximal gastrectomy for EGJ cancer,demonstrating excellent anti-reflux efficacy.
作者
王利明
蔡旭浩
温浩祥
马浩越
孙鹏
陈瑛罡
Wang Liming;Cai Xuhao;Wen Haoxiang;Ma Haoyue;Sun Peng;Chen Yinggang(Department of Gastrointestinal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,Guangdong,China;Department of Hepatobiliary Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,Guangdong,China)
出处
《消化肿瘤杂志(电子版)》
2025年第4期509-515,共7页
Journal of Digestive Oncology(Electronic Version)
基金
深圳市高水平医院建设基金。
关键词
食管胃结合部癌
单肌瓣成形术
近端胃切除
Esophagogastric junction cancer
Single flap valvuloplasty
Proximal gastrectomy
