• 医学文献
  • 知识库
  • 评价分析
  • 全部
  • 中外期刊
  • 学位
  • 会议
  • 专利
  • 成果
  • 标准
  • 法规
  • 临床诊疗知识库
  • 中医药知识库
  • 机构
  • 作者
热搜词:
换一批
论文 期刊
高级检索

检索历史 清除

食管胃结合部腺癌切除后消化道重建的体会与思考

Experience and thoughts on digestive tract reconstruction after radical resection of adenocarcinoma of the esophagogastric junction

摘要:

在食管胃结合部腺癌(AEG)的外科治疗策略中,淋巴结清扫范围、手术入路选择、肿瘤切除范围及消化道重建等问题一直存在争议,尤其AEG术后消化道重建面临着诸多挑战。其消化道重建方式与切除范围相关。目前,全胃切除术后消化道重建方式有Roux-en-Y吻合、空肠间置法及其衍生术式,依据重建方式不同,可分为管型吻合、线型吻合以及手工吻合。近端胃切除术后抗反流消化道重建方式主要有食管胃吻合、间置空肠和双通道吻合3类,目前,国内较常用的重建方式为双通道吻合。笔者基于间置管状胃及重建胃角抗反流的理念,提出"Giraffe"吻合,将人工胃底及His角下移,保留更多的残胃,显示了良好的胃排空及抗反流效果。本文中,我们就AEG术后消化道重建的方式选择和技术要点,结合自身的临床经验和体会,对相关问题进行思考和探讨,并提出,复合的抗反流机制设计,可能是未来抗反流重建方式设计的发展趋势,包括基于保留胃体中部大弯侧的胃电起搏点以增加残胃排空能力、重建的胃底及His角抗反流屏障、间置管状胃发挥缓冲带作用的理念设计的"Giraffe"吻合等。

更多
abstracts:

In the surgical treatment of adenocarcinoma of the esophagogastric junction (AEG), the scope of lymph node dissection, surgical approach selection, extent of tumor resection and digestive tract reconstruction have always been controversial, with the digestive tract reconstruction in AEG facing many challenges especially. The digestive tract reconstruction is related to the extent of resection. At present, the digestive tract reconstruction after total gastrectomy includes Roux-en-Y anastomosis, jejunum interposition and its derivatives. According to different reconstruction methods, they can be divided into tube anastomosis, linear anastomosis and manual anastomosis. Anti-reflux digestive tract reconstruction after proximal gastrectomy mainly includes esophagogastric anastomosis, interposition jejunum and double channel anastomosis. At present, double channel anastomosis is the most common reconstruction method in China. Based on the concept of interposition tubular stomach and reconstruction of gastric angle for anti-reflux, we propose "Giraffe" anastomosis, which moves artificial fundus and His angle downward to retain more residual stomach, showing good gastric emptying and anti-reflux effect. In this paper, combined with our clinical experience and understanding, we discuss the selection and technical key points of digestive tract reconstruction methods in AEG, and suggest that composite anti-reflux mechanism design may be the development trend of anti-reflux reconstruction in the future. The composite mechanism includes the retention of gastric electrical pacemaker in greater curvature of the middle part of gastric body to increase the emptying capacity of residual stomach, the reconstruction of gastric fundus and His angle anti-reflux barrier, and the establishment of an interposition tubular stomach acting as a buffer zone in Giraffe construction, and so on.

More
作者: 张延强 [1] 黄灵 [1] 徐志远 [1] 程向东 [1]
期刊: 《中华胃肠外科杂志》2022年25卷5期 385-391页 MEDLINEISTICPKUCSCD
栏目名称: 专题论坛
DOI: 10.3760/cma.j.cn441530-20220331-00125
发布时间: 2022-07-31
  • 浏览:11
  • 下载:0

加载中!

相似文献

  • 中文期刊
  • 外文期刊
  • 学位论文
  • 会议论文

加载中!

加载中!

加载中!

加载中!

扩展文献

特别提示:本网站仅提供医学学术资源服务,不销售任何药品和器械,有关药品和器械的销售信息,请查阅其他网站。

  • 客服热线:4000-115-888 转3 (周一至周五:8:00至17:00)

  • |
  • 客服邮箱:yiyao@wanfangdata.com.cn

  • 违法和不良信息举报电话:4000-115-888,举报邮箱:problem@wanfangdata.com.cn,举报专区

北京万方数据股份有限公司

万方数据电子出版社

京ICP证010071号

京公网安备11010802020237号

京ICP备08100800号-1

违法和不良信息举报电话:4000-115-888,举报邮箱:problem@wanfangdata.com.cn,举报专区

充值 订阅 收藏 移动端 使用
帮助