中国实用外科杂志

中国实用外科杂志

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腹腔镜胃癌手术中高位食管离断双肌瓣吻合技术要点

朱甲明，孙景旭，王    鑫，郭彭涛，那    迪   

  1. 中国医科大学附属第一医院胃肠肿瘤外科  胃肠肿瘤精准诊疗教育部重点实验室（中国医科大学），辽宁沈阳110001
  • 出版日期:2023-09-01

  • Online:2023-09-01

摘要： 腹腔镜下双肌瓣吻合是近端胃切除消化道重建的方法之一，其利用吻合口两侧胃壁肌瓣包裹食管-胃吻合口，可压迫人工胃底以实现抗反流的目的。经过长期的探索和改进，双肌瓣吻合所重建的吻合口结构已经与自然贲门的功能接近。双肌瓣吻合技术在高位食管离断病例中的应用目前已被认为是较理想的消化道重建方式，病人术后营养状态较好，且吻合口漏、严重反流等并发症发生率较低。但其操作较为复杂，尤其在全腹腔镜下进行重建，对于腹腔镜操作初学者可能较为困难，且容易引起吻合口狭窄等并发症。随着操作方法和流程的规范化和程序化，该吻合方式仍有较大的推广和普及空间。目前有关高位食管离断双肌瓣吻合的临床研究仍然较少，且多以单中心或回顾性研究为主。期待未来对其进行更多的大型、多中心、前瞻性研究，以提供更多循证医学证据。

关键词: 腹腔镜手术, 胃癌, 高位食管离断, 双肌瓣吻合

Abstract: Technical points of high esophageal transection and double muscular flap anastomosis in laparoscopic gastrectomy for gastric cancer        ZHU Jia-ming，SUN Jing-xu, WANG Xin, et al. Department of Gastrointestinal Oncology, the First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment for Gastrointestinal Tumors, Ministry of Education (China Medical University)，Shenyang110001，China
Corresponding author：ZHU Jia-ming，E-mail:zhujiaming75@sina.com
Abstract    Double muscular flap anastomosis is one of the methods of digestive tract reconstruction after proximal gastrectomy, which uses the gastric wall muscular flaps on both sides of the anastomosis to cover the esophagogastric anastomosis, and can compress the artificial gastric fundus to achieve the purpose of anti-reflux. After long-term exploration and improvement, the structure of the anastomosis reconstructed by double muscular flap anastomosis has been close to the function of the natural cardia. The application of double muscular flap anastomosis technique in cases with high esophageal transection is currently considered to be a more ideal digestive tract reconstruction technique, with better postoperative nutritional status and lower incidence of complications such as anastomotic leakage and severe reflux. However, its operation is more complicated, especially when performing reconstruction under total laparoscopy, which may be more difficult for laparoscopic beginners and may easily cause complications such as anastomotic stenosis. With the standardization and proceduralization of the operation methods and procedures, this anastomosis method still has a large space for promotion and popularization. At present, there are still few clinical studies on high esophageal transection and double muscular flap anastomosis, and most of them are single-center or retrospective studies. We look forward to more large-scale, multi-center, prospective studies in the future to provide more evidence-based medical evidence.

Key words: laparoscopic surgery, gastric cancer, high esophagogastric junction reconstruction, double-flap anastomosis