Liu Lang-Biao, Ruan Guo-Tian, Wu Ya-Dong, Niu Lei, Cai Jun
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China.
Front Oncol. 2024 Aug 9;14:1335297. doi: 10.3389/fonc.2024.1335297. eCollection 2024.
Common gastrectomy methods can significantly affect patients' postoperative quality of life. This study investigated the safety, feasibility, and short-term efficacy of λ-type esophagojejunostomy in total gastrectomy under total laparoscopy.
We retrospectively analyzed the clinical and follow-up data of 50 patients with adenocarcinoma of the gastric/gastroesophageal junction who underwent total laparoscopic radical gastrectomy with λ-type esophagojejunostomy at the Beijing Friendship Hospital from January 2021 to July 2022. Data are reported as mean ± standard deviation.
Patients comprised 27 males and 23 females, aged 42 to 76 (60.9 ± 5.6) years. There were 26 cases of gastroesophageal junction adenocarcinoma (16 Siewert type II and 10 Siewert type III) and 24 cases of adenocarcinoma of the proximal gastric body. All patients underwent radical total gastrectomy and D2 lymph node dissection with λ-type esophagojejunostomy for digestive tract reconstruction under total laparoscopy. The total operation time was 235-295 (249.4 ± 48.5) min, digestive tract reconstruction time was (48.2 ± 23.2) min, intraoperative blood loss was (63.4 ± 48.4) mL, recovery time of exhaust was (3.1 ± 2.2) d, first drinking or eating time was (4.1 ± 2.1) d, and hospital stay was (9.3 ± 4.4) d. Three patients had postoperative complications, including one with duodenal remnant leakage combined with abdominal infection. Anastomotic bleeding and postoperative inflammatory intestinal obstruction occurred in one patient each, all of whom were cured by conservative treatment. The Nutritional Risk Index of the whole group was 53.5 ± 8.4 preoperatively, 47.3 ± 5.6 one week postoperatively, 50.3 ± 5.6 six months postoperatively, and 52.4 ± 4.2 at 12 months postoperatively. Roux-en-Y stasis syndrome and bile reflux esophagitis occurred in one patient each (2.0%). There were no occurrences of recanalization of the closed end of the afferent loop of the esophagojejunostomy anastomosis, anastomotic stricture or obstruction, or tumor recurrence.
λ-type esophagojejunostomy is safe and feasible for digestive tract reconstruction after total laparoscopic radical gastrectomy. This digestive tract reconstruction method not only maintains intestinal continuity but also simplifies surgical procedures, allowing patients to recover quickly with an excellent short-term effect.
常见的胃切除方法会显著影响患者术后的生活质量。本研究探讨了全腹腔镜下全胃切除术中λ型食管空肠吻合术的安全性、可行性及短期疗效。
回顾性分析2021年1月至2022年7月在北京友谊医院接受全腹腔镜根治性全胃切除并λ型食管空肠吻合术的50例胃/胃食管交界腺癌患者的临床及随访资料。数据以均值±标准差表示。
患者包括27例男性和23例女性，年龄42至76（60.9±5.6）岁。胃食管交界腺癌26例（16例SiewertⅡ型和10例SiewertⅢ型），胃体近端腺癌24例。所有患者均在全腹腔镜下接受根治性全胃切除及D2淋巴结清扫，并采用λ型食管空肠吻合术进行消化道重建。总手术时间为235 - 295（249.4±48.5）分钟，消化道重建时间为（48.2±23.2）分钟，术中出血量为（63.4±48.4）毫升，排气恢复时间为（3.1±2.2）天，首次饮水或进食时间为（4.1±2.1）天，住院时间为（9.3±4.4）天。3例患者出现术后并发症，其中1例十二指肠残端漏合并腹腔感染。吻合口出血和术后炎性肠梗阻各发生1例，均经保守治疗治愈。全组术前营养风险指数为53.5±8.4，术后1周为47.3±5.6，术后6个月为50.3±5.6，术后12个月为52.4±4.2。Roux-en-Y淤滞综合征和胆汁反流性食管炎各发生1例（2.0%）。食管空肠吻合口输入袢封闭端再通、吻合口狭窄或梗阻及肿瘤复发均未发生。
λ型食管空肠吻合术用于全腹腔镜根治性全胃切除术后消化道重建安全可行。这种消化道重建方法不仅保持了肠道连续性，还简化了手术操作，使患者恢复快，短期效果良好。
