Otsuka Ryota, Hayashi Hideki, Hanari Naoyuki, Gunji Hisashi, Hayano Koichi, Kano Masayuki, Matsubara Hisahiro
Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Japan.
Ann Med Surg (Lond). 2017 Aug 1;21:105-108. doi: 10.1016/j.amsu.2017.07.080. eCollection 2017 Sep.
When gastric cancer or carcinoid patients have coexisting diseases such as duodenal adenoma, FAP, or Crohn's disease, periodic observation of the duodenum is necessary.
Between August 2013 and April 2015, we performed four consecutive laparoscopic total gastrectomies with double tract reconstruction for duodenal surveillance. Three of the patients were diagnosed with gastric cancer, while the remaining patient was diagnosed with gastric carcinoid.
No deaths occurred, and three of the patients showed no early complications. One patient with Crohn's disease developed anastomotic leakage, but it was successfully managed conservatively. On endoscopy three to seven months later, we were able to observe the duodenum via jejunal anastomosis in all of the patients.
Roux-en-Y reconstruction is one of the options after laparoscopic total gastrectomy. However, given that periodical endoscopic examinations of the duodenum are strongly recommended after surgery, double-tract reconstruction may be preferable in these patients.
Although more detailed data are required, double-tract reconstruction may be the best choice for patients requiring total gastrectomy with regular check-up of the duodenum.
当胃癌或类癌患者合并十二指肠腺瘤、家族性腺瘤性息肉病（FAP）或克罗恩病等疾病时，有必要定期观察十二指肠。
2013年8月至2015年4月期间，我们连续进行了4例腹腔镜全胃切除术并采用双通路重建以进行十二指肠监测。其中3例患者被诊断为胃癌，其余1例患者被诊断为胃类癌。
无死亡病例发生，3例患者未出现早期并发症。1例患有克罗恩病的患者发生了吻合口漏，但通过保守治疗成功处理。在术后三至七个月进行内镜检查时，我们能够通过空肠吻合口观察到所有患者的十二指肠。
Roux-en-Y重建是腹腔镜全胃切除术后的选择之一。然而，鉴于术后强烈建议定期对十二指肠进行内镜检查，双通路重建可能更适合这些患者。
尽管需要更详细的数据，但对于需要全胃切除并定期检查十二指肠的患者，双通路重建可能是最佳选择。
