Hirai Toshihiro, Matsumoto Hideo, Iki Katsumichi, Hirabayashi Yoko, Kawabe Yukiko, Ikeda Masaharu, Yamamura Masahiro, Hato Shinji, Urakami Atsushi, Yamashita Kazuki, Tsunoda Tsukasa, Haruma Ken
Departments of Gastroenterological Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 710-0192, Japan.
Surg Today. 2006;36(10):874-8. doi: 10.1007/s00595-006-3265-y.
Proximal gastrectomy and lymph node dissection are often performed for T1 cancer of the gastric cardia; however, direct esophagogastrostomy is frequently complicated by reflux esophagitis. We describe a simple technique for preventing esophageal reflux and discuss its results.
This technique is indicated for T1 cancer of the gastric cardia without lymphadenopathy. Partial resection, including the lesion, is performed, preserving the vagus nerve and lower esophageal sphincter (LES). Lymph node dissection is done around the left gastric, celiac, and splenic arteries. The esophagus is then anastomosed to the anterior wall in the center of the remnant stomach.
We evaluated the results of this procedure in eight patients. X-ray films showed no esophageal reflux in either the supine or the right decubitus position. None of the patients complained of reflux or other dyscrasic symptoms, and none had any feeling of microgastria. One patient had some localized erosion near the anastomosis.
This simple and safe technique does not result in post-gastrectomy syndrome or microgastria, and the risk of leaving cancer cells is minimal.
近端胃切除术及淋巴结清扫术常用于治疗贲门T1期癌；然而，直接食管胃吻合术常并发反流性食管炎。我们描述一种预防食管反流的简单技术并讨论其结果。
该技术适用于无淋巴结肿大的贲门T1期癌。进行包括病变部位的部分切除术，保留迷走神经和食管下括约肌（LES）。在胃左动脉、腹腔动脉和脾动脉周围进行淋巴结清扫。然后将食管吻合至残胃中央的前壁。
我们评估了8例患者采用该手术方法的结果。X线片显示，无论是仰卧位还是右侧卧位均无食管反流。所有患者均未主诉反流或其他不适症状，也均无小胃的感觉。1例患者在吻合口附近有一些局限性糜烂。
这种简单且安全的技术不会导致胃切除术后综合征或小胃，且残留癌细胞的风险极小。
