食管管状胃吻合在上消化道手术中的发展及应用

Development and application of esophageal gastric-tube reconstruction in upper gastrointes-tinal surgery

  • 摘要: 胃癌和食管癌均是我国发病率较高的上消化道恶性肿瘤,近年来食管胃结合部腺癌(AEG)发病率呈上升趋势。外科手术是AEG的主要治疗策略,但手术方式及消化道重建路径仍有较大争议,AEG术后消化道重建方式有传统的全胃切除术+Roux‑en‑Y吻合或近端胃切除术+食管管状胃吻合/双通道吻合/双肌瓣吻合等。随着外科手术的发展,与传统全胃切除后食管空肠吻合比较,食管管状胃吻合成为AEG术后较常见的消化道重建方式,可降低吻合口漏、反流性食管炎、吻合口狭窄以及患者远期营养不良等术后并发症发生率。为了进一步降低术后并发症,新技术的应用及手术方式的改良成为近年来的研究重点,笔者主要回顾食管管状胃吻合的发展历史,并对食管管状胃吻合的现况、重建路径、吻合位置及方式、术后并发症等进行系统阐述。

     

    Abstract: Gastric cancer and esophageal cancer are the top ranked malignant tumors of the upper gastrointestinal tract in China, and the incidence of adenocarcinoma of esophagogastric junction (AEG) has been on the rise in recent years. Currently, surgery is the main treatment strategy for AEG, but the surgical approach and the path of digestive tract reconstruction are still contro-versial. The digestive tract reconstruction after AEG surgery include traditional total gastrectomy + Roux-en-Y reconstruction or proximal gastrectomy + esophageal gastric-tube reconstruction/double-tract reconstruction/double-flap technique reconstruction. With the development of surgery, esophageal gastric-tube reconstruction has become a common digestive tract reconstruction modality after AEG compared with traditional esophagojejunal reconstruction of total gastrectomy, which can reduce the incidence of postoperative complications such as anastomotic leakage, reflux esophagitis, anasto-motic stricture, and patients' malnutrition in the long term. In order to further reduce postoperative complications, the application of new techniques and improvement of surgical methods have become the focus of research in recent years. The authors review the history of the development of esopha-geal gastric-tube reconstruction and provides an overview of the current status of esophageal gastric-tube reconstruction, reconstruction pathway, anastomotic position and modality, and research on the reduction of postoperative complications.

     

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