Furukawa Haruna, Kawabata Ryohei, Miyagaki Hiromichi, Yoshikawa Yukihiro, Sueda Toshinori, Matsumura Tae, Koga Chikato, Wakasugi Masaki, Tei Mitsuyoshi, Tsujie Masanori, Hasegawa Junichi
Dept. of Surgery, Osaka Rosai Hospital.
Gan To Kagaku Ryoho. 2020 Dec;47(13):1824-1826.
We report 2 cases with esophagogastric junction(EGJ)cancer who underwent remnant gastrectomy preserving Braun anastomosis after subtotal stomach-preserving pancreaticoduodenectomy(SSPPD)with modified Child's reconstruction. In case 1, a 73-year-old man was diagnosed with EGJ cancer 4 years after SSPPD for stenosis of lower bile duct. He underwent remnant gastrectomy with Roux-en-Y(R-Y)reconstruction preserving Braun anastomosis using linear stapler(overlap method). In case 2, a 77-year-old man, who underwent SSPPD for intraductal papillary mucinous neoplasm 1 year ago, was performed endoscopic submucosal dissection for EGJ cancer and planned additional gastrectomy, because of non-curative resection. He was performed remnant gastrectomy with R-Y reconstruction preserving Braun anastomosis using circular stapler. In both patients, the postoperative courses were favorable without complication. Remnant gastrectomy after PD is difficult because of anatomical changes due to adhesions and gastrointestinal reconstruction. R-Y reconstruction preserving Braun anastomosis may be a useful surgical procedure for remnant gastric cancer after SSPPD.
我们报告了2例食管胃交界（EGJ）癌患者，他们在接受保留部分胃的胰十二指肠切除术（SSPPD）并采用改良Child法重建后，行保留Braun吻合的残胃切除术。病例1为一名73岁男性，因低位胆管狭窄在SSPPD术后4年被诊断为EGJ癌。他接受了保留Braun吻合的Roux-en-Y（R-Y）重建残胃切除术，使用直线切割吻合器（重叠法）。病例2为一名77岁男性，1年前因导管内乳头状黏液性肿瘤接受了SSPPD，因内镜下黏膜下剥离术对EGJ癌切除不彻底，计划再次行胃切除术，遂接受了保留Braun吻合的R-Y重建残胃切除术，使用圆形吻合器。两名患者术后恢复良好，均无并发症。由于粘连导致的解剖结构改变和胃肠道重建，PD术后的残胃切除术具有挑战性。保留Braun吻合的R-Y重建可能是SSPPD术后残胃癌的一种有效手术方法。
