Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Sichuan, 610041, Chengdu, People's Republic of China.
Chest Oncology Institute, West China Hospital, Sichuan University, Chengdu, China.
BMC Surg. 2022 Jun 11;22(1):225. doi: 10.1186/s12893-022-01630-y.
The gastric conduit is the best replacement organ for oesophageal reconstruction, but a reversed gastric conduit (RGC) is rare. Oesophageal reconstruction for oesophageal cancer patients with a previous history of complicated gastrointestinal surgery is rather difficult. Here, we report a case in which oesophageal reconstruction was successfully managed using RGC based solely on the left gastroepiploic artery supply.
A 69-year-old man with oesophageal cancer had a history of endoscopic intestinal polypectomy and pylorus-preserving pancreaticoduodenectomy (PPPD). The right gastroepiploic artery and right gastric artery had been completely severed. The only supply artery that could be used for the gastric conduit was just the left gastroepiploic artery. Because of the complex history of abdominal surgery, we had no choice but to use the RGC to complete the oesophageal reconstruction, in which the gastric conduit was passed reversely through the hiatus to the oesophageal bed and layered end-to-side manual intrathoracic anastomosis with the esophagus. The patient had transient feeding problems with postoperative delayed thoracic stomach emptying but no anastomotic stenosis or thoracic stomach fistula. He was satisfied with his life and had no long-term complications. There was no significant effect on gut physiological function, and RGC could work normally.
Oesophageal reconstruction with RGC is a feasible procedure for complex oesophageal carcinoma that can simplify complicated surgical procedures, has less influence on gut function, is less invasive, and is safe.
胃管是食管重建的最佳替代器官，但胃管倒置（RGC）很少见。对于有复杂胃肠道手术史的食管癌患者，进行食管重建相当困难。在这里，我们报告了一例成功使用仅基于左胃网膜动脉供应的 RGC 进行食管重建的病例。
一名 69 岁男性患有食管癌，曾行内镜肠息肉切除术和保留幽门的胰十二指肠切除术（PPPD）。右胃网膜动脉和右胃动脉已完全切断。胃管唯一可用的供应动脉只是左胃网膜动脉。由于腹部手术的复杂病史，我们别无选择，只能使用 RGC 完成食管重建，其中胃管通过裂孔逆行穿过食管床，并与食管进行端侧手动胸内吻合。患者术后出现短暂的喂养问题，表现为胸腔胃排空延迟，但无吻合口狭窄或胸腔胃瘘。他对自己的生活感到满意，没有长期并发症。对肠道生理功能没有明显影响，RGC 可以正常工作。
RGC 用于复杂食管癌的食管重建是一种可行的方法，它可以简化复杂的手术程序，对肠道功能的影响较小，创伤较小，且安全。
