目的探索經臍單孔加一孔全腹腔鏡近端胃切除間置空腸殘胃空腸雙通道吻合術（single incision plus one port laparoscopic proximal gastrectomy with double-tract anastomosis，SILP-DT）治療早期胃癌的手術可行性及近期手術安全性。方法回顧性分析2023年10月至2024年1月期間襄陽市中心醫院胃腸外科行SILP-DT治療的5例早期胃癌患者的臨床資料。結果5例患者均為男性，平均年齡66歲，身體質量指數平均21.8 kg/m2。胃鏡檢查提示食管胃結合部癌（Siewert Ⅱ或Ⅲ型），TNM分期為cT1-2N0M0。5例患者行SILP-DT均順利完成，手術時間（180.0±25.5）min，術中出血量（7.5±2.5）mL，術后第1天疼痛評分均為1～2分，術后首次排氣時間（56.6±16.0）h、首次進食時間（2.6±0.6）d，術后拔除胃管時間（3.6±0.6）d、拔除引流管時間（6.0±1.0）d，術后住院時間（7.8±0.8）d。術后病理均為胃腺癌，切緣均陰性，高分化1例、中分化3例、低分化1例，清掃淋巴結（22.4±3.8）枚/例，均無淋巴結轉移。5例患者于術后1個月時在胃腸外科門診行上消化道造影檢查見吻合口均通暢，無造影劑反流入食管。術后無出血、吻合口漏及死亡發生，腹壁切口美容效果良好。隨訪截至2024年10月，無腫瘤復發及轉移。結論本組經臍SILP-DT術治療的5例早期胃癌患者的結果提示，該手術有微創優勢，方法技術上可行，近期手術安全。
Objective To summarize the research progress of digestive tract reconstruction after total gastrectomy in gastric cancer. Methods The domestic and international published literatures about digestive tract reconstruction after total gastrectomy in gastric cancer were retrieved and reviewed. Results More and more attention had been paid to the postoperative quality of life after total gastrectomy in gastric cancer， and the most related factor for postoperative quality of life was the type of digestive tract reconstruction. The pouch reconstruction and preservation of enteric myoneural continuity showed beneficial effects on clinical outcomes. Current opinion considered the pouch reconstruction might be safe and effective， and was able to improve the postoperative quality of life of patients with gastric cancer. However， the preservation of duodenal pathway didn’t show significant benefits. Conclusion The optimal digestive tract reconstruction after total gastrectomy is still debating， in order to resolve the controversies， needs more in-depth fundamental researches and more high-quality randomized controlled trials.
Objective To explore the feasibility of arch-preserved jejunum in total gastrectomy with Roux-en-Y esophagojejunostomy for adenocarcinoma of esophagogastric junction （AEG） and upper-middle gastric cancer. Methods Clinical data of 13 patients who underwent total gastrectomy with Roux-en-Y esophagojejunostomy with usage of arch-preserved jejunum to resolve the anastomosis tension problem in our hospital from Dec. 2012 to Apr. 2013 were analyzedretrospectively， and surgical experience was summarized. Results The maximal and actual extended lengths were （7.75±1.75） cm （4-10 cm） and （5.95±1.82） cm （3-9 cm） respectively， with the utilization percentage of （77.91±16.60）% （50.0%-100.0%）. These patients hadn’t suffered postoperative mortality and severe complications， such as anastomosis leakage， stenosis， hemorrhage， and so on. Besides， there were 1 case complicated with postoperative acute urinary retention and another 1 case complicated with infra-hepatic space abscess and peritoneal infection. Conclusion Arch-preserved jejunum is a practical surgical technique to handle with the anastomosis tension of esophagojejunostomy in total gastrectomy for AEG and upper-middle gastric cancer.
Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction: one group with gastroesophagostomy (GE group) and the other with accommodation double tract digestive reconstruction of jejunal interposition (GIE group). The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation: the value of weight, RBC, Hb, Alb, PNI and the indexes versus the preoperative ones (Pgt;0.05), for the exception of the indexes of RBC (P=0.006), Hb (P=0.001) in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group (Plt;0.001). The Visick scoring: most of the GIE group were gradeⅡ (74.2%), and grade Ⅲ (64.3%) in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group (Pgt;0.05), and the surgical time was (0.35±0.13) h more than that of GE group (P=0.01). Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.
Objective To evaluate whether jejunal interposition pouch (JIP) reconstruction is an ideal procedure of digestive tract reconstruction after total gastrectomy. Methods Ninetyfour patients after total gastrectomy had randomly divided into two groups, JIP group 42 cases and RouxenY pouch (RYP) group 52 cases. The gastrointestinal function improvement in body weight and nutritional parameters (serum albumin, hemoglobin level, and serum protein) were compared 1 year after surgery for the two groups. Results The nutritional condition of JIP group and RYP group after operation had improved (P＜0.01); and the condition of JIP group with fewer symptom problems demonstrated much more better than standard RYP group （P＜0.01）. Conclusion JIP that could obtain partly compensatory function after total gastrectomy is an ideal reconstruction.
Objective To describe a new technique for digestive tract reconst ruction of total gast rectomy.Methods The modified functional jejunal interposition ( FJ I) was performed in 38 patient s who underwent total gastrectomy between June 2004 and March 2006. At digestive tract reconst ruction, the jejunum with suitable suture ligated at 2 cm distal to side-to-end jejunoduodenostomy was changed to sew up 2－3 needles and to narrow it . End-to-side esophagojejunostomy to Treitz ligament was shortened to 20－25 cm befittingly. Side2to2side jejunojejunostomy to Treitz ligament was 10 cm. Both esophagojejunostomy and jejunojejunostomy must not be tensioned. Results No patients died or had anastomotic leakage in perioperative period. Roux-en-Y stasis syndrome (RSS) was in 2 patients. The Visick grade: 35 patient s were grade Ⅰ, 3 patient s were grade Ⅱ. Serum nut ritional parameters in 2 patients hemoglobin was only lower than normal. At 6 months after operation , food intake per meal and body weight were recovered to the preoperative level in 36 patients, and only 2 patients appeared weight worse. One patient had reflux esophagitis and no dumping syndrome occurred. Through the upper gast rointestinal radiograph , the bariums entered into duodenal channels mostly , and a little into the narrow channels. Conclusion The modified FJ I not only reserved all advantages of the primary procedure , but also could further lower the complications and improve of the quantity life of the patients who were underwent total gast rectomy. It would be necessary for further prospective randomized controlled trial in tlhe largescale cases.
