Hosoda Kei, Yamashita Keishi, Moriya Hiromitsu, Mieno Hiroaki, Ema Akira, Washio Marie, Watanabe Masahiko
Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
J Gastrointest Surg. 2017 Jul;21(7):1174-1180. doi: 10.1007/s11605-016-3341-6. Epub 2016 Dec 26.
Laparoscopy-assisted proximal gastrectomy (LAPG) with esophagogastrostomy using a novel "open-door" technique was introduced recently, with the aim of preventing gastroesophageal reflux. However, quantitate assessment of gastroesophageal reflux after this surgery has not been performed till date. The aims of the current study were to investigate the safety and feasibility of this operation and to elucidate the postoperative reflux status. Twenty consecutive patients (18 men) with (y)cStage I gastric cancer in the upper third of the stomach who underwent LAPG at Kitasato University Hospital from May 2015 through September 2016 were retrospectively reviewed. We performed 24-h impedance-pH monitoring 3 months after surgery for the first eight patients and analyzed the postoperative reflux status. Median operation time was 333 min, while median anastomotic time was 81 min. None of the 20 patients experienced anastomotic leakage while two patients experienced anastomotic stricture requiring endoscopic balloon dilatation. No patient experienced heartburn without antacid drugs. During the 24-h impedance-pH monitoring, all but one patient had normal gastroesophageal acid reflux with the acid percent time of <1.1% and reflux percent time of <1.4%. One patient with marginally abnormal postoperative gastroesophageal reflux had a normal DeMeester score of 3.0. Our results showed that esophagogastrostomy using the "open-door" technique is a safe and feasible procedure for LAPG. The degree of gastroesophageal reflux was acceptable using this technique. Randomized controlled trials with long-term follow-ups are required to confirm that this technique would be superior to the others.
最近引入了一种采用新型“开门”技术行食管胃吻合术的腹腔镜辅助近端胃切除术（LAPG），旨在预防胃食管反流。然而，迄今为止尚未对该手术后的胃食管反流进行定量评估。本研究的目的是探讨该手术的安全性和可行性，并阐明术后反流情况。回顾性分析了2015年5月至2016年9月在北里大学医院接受LAPG的连续20例（18例男性）胃上1/3（y）cⅠ期胃癌患者。我们对前8例患者在术后3个月进行了24小时阻抗-pH监测，并分析了术后反流情况。中位手术时间为333分钟，中位吻合时间为81分钟。20例患者均未发生吻合口漏，2例患者发生吻合口狭窄，需要内镜下球囊扩张。没有患者在未使用抗酸药物的情况下出现烧心症状。在24小时阻抗-pH监测期间，除1例患者外，所有患者的胃食管酸反流均正常，酸反流时间百分比<1.1%，反流时间百分比<1.4%。1例术后胃食管反流轻度异常的患者DeMeester评分为3.0，结果正常。我们的结果表明，采用“开门”技术行食管胃吻合术对LAPG来说是一种安全可行的手术。使用该技术时胃食管反流程度是可以接受的。需要进行长期随访的随机对照试验来证实该技术优于其他技术。
