中国实用外科杂志

中国实用外科杂志

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全腹腔镜食管胃结合部肿瘤切除术后消化道重建方式的争议与共识

徐泽宽，王林俊，徐    皓   

  1. 南京医科大学第一附属医院普外科，江苏南京210029
  • 出版日期:2018-02-01 发布日期:2018-02-24

  • Online:2018-02-01 Published:2018-02-24

摘要：

全腹腔镜食管胃结合部肿瘤切除术后消化道重建分为全腹腔镜近端胃切除术后消化道重建及全腹腔镜全胃切除术后消化道重建。这两类重建方式又分成不同的术式，其中部分重建方式的功效仍存争议。全胃切除术目前仍是食管胃结合部肿瘤的主要手术方式；近端胃切除术应用较少，但其术后抗反流重建方式的出现有望扩大近端胃切除术的适应证。管形吻合能够获得较高的切缘，适用于各种类型的食管胃结合部肿瘤；直线形吻合的全过程均可在腹腔镜下完成，主要适用于Siewert Ⅲ型食管胃结合部肿瘤。对于全腹腔镜全胃切除术后消化道重建，如何保证食管空肠吻合口的安全，降低吻合口相关并发症发生率是争议的焦点。对于全腹腔镜近端胃切除术后消化道重建，各种重建方式是否具有抗反流功效仍然需要高级别研究证据来证实。在临床实践中，术者须在遵守消化道重建一般原则的基础上，结合病人自身情况，以病人为中心，选择合适的消化道重建方式。

关键词: 食管胃结合部肿瘤, 腹腔镜, 胃切除术, 消化道重建, 吻合

Abstract:

Controversies and consensuses on totally laparoscopic digestive tract reconstruction after gastrectomy for esophagogastric junction cancer        XU Ze-kuan, WANG Lin-jun, XU Hao. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Corresponding author: XU Ze-kuan, E-mail：xuzekuan@njmu.edu.cn
Abstract    Totally laparoscopic digestive tract reconstruction after gastrectomy for esophagogastric junction cancer is divided into totally laparoscopic reconstruction after proximal gastrectomy and totally laparoscopic reconstruction after total gastrectomy. The two types of reconstruction are divided into different methods, and some methods remain controversial. As to the extent of gastrectomy for esophagogastric junction cancer, total gastrectomy is the main method, while the application of proximal gastrectomy is still limited. However, the usage of anti-reflux reconstruction after proximal gastrectomy is expected to improve the indication of proximal gastrectomy. Circular-shaped anastomosis can obtain higher esophageal margin, and is applied for all types of esophagogastric junction cancer. While, the whole process of linear-shaped anastomosis can be performed laparoscopically, and it is mainly suitable for Siewert type Ⅲ esophagogastric junction cancer. As to totally laparoscopic reconstruction after total gastrectomy, the focus of controversy is that how to ensure the safety of esophagojejunostomy and reduce the incidence of anastomotic complications. As to totally laparoscopic reconstruction after proximal gastrectomy, high levels of evidence is needed to confirm the anti-reflux functions of reconstruction methods. In clinic, surgeons should select suitable digestive tract reconstruction method on the basis of the general principles of digestive tract reconstruction and patient-centered principle, combining with the patient's condition.

Key words: esophagogastric junction cancer；laparoscope, gastrectomy；digestive tract reconstruction；anastomosis