Peng Rui, Shi Yun, Zhang Hao, Xie Qing-Yu, Yue Chao, Huang Ling-Li, Chen Liang, Sun Guang-Li, Xu Wei-Guo, Wei Wei, Gu Rong-Min, Ming Xue-Zhi, Chen Huan-Qiu, Li Gang
Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China.
Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China; Department of Thoracic Surgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
J Gastrointest Surg. 2025 Jan;29(1):101871. doi: 10.1016/j.gassur.2024.10.026. Epub 2024 Oct 28.
The prevalence of proximal gastric cancer (PGC) has been increasing rapidly worldwide. Postoperative reflux esophagitis after conventional esophagogastrostomy (EG) is a major problem that haunts surgeons. This study designed a novel antireflux technique called tunnel anastomosis in EG after proximal gastrectomy (PG). This study aimed to present the detailed procedures of tunnel anastomosis and to assess its safety and feasibility by comparing the surgical outcomes, reflux, and nutritional status of patients undergoing tunnel anastomosis and those undergoing double-tract jejunal interposition reconstruction (DTJIR).
A total of 1718 patients undergoing gastrectomy were enrolled in this study. However, only 150 patients undergoing PG were ultimately analyzed, of which 21 patients underwent tunnel anastomosis and 129 patients underwent DTJIR. Propensity score matching (PSM) was used to reduce biases.
After 1:1 PSM, there were 21 patients in both groups. No significant differences were observed between the 2 groups regarding surgical approach, blood loss, operative time, reconstruction time, postoperative hospital stay, morbidity, and mortality. The incidence of reflux esophagitis in both groups was 9.5% (2/21) according to the endoscopic examination at the 12-month postoperative follow-up. No patient in the tunnel group was classified as grade B or higher according to the Los Angeles classification. Patients in the tunnel and DTJIR groups exhibited comparable postoperative nutritional status when assessing the body weight, albumin levels and prognostic nutritional index value at 3 and 6 months after surgery.
Tunnel anastomosis is a safe technique that offers a robust antireflux effect and can be performed in some suitable patients with PGC.
近端胃癌（PGC）在全球范围内的发病率一直在迅速上升。传统食管胃吻合术（EG）术后的反流性食管炎是困扰外科医生的一个主要问题。本研究设计了一种新型抗反流技术，即近端胃切除术后（PG）食管胃吻合术中的隧道吻合术。本研究旨在介绍隧道吻合术的详细操作步骤，并通过比较接受隧道吻合术和双束空肠间置重建术（DTJIR）患者的手术结果、反流情况和营养状况，评估其安全性和可行性。
本研究共纳入1718例行胃切除术的患者。然而，最终仅对150例行PG的患者进行了分析，其中21例接受了隧道吻合术，129例接受了DTJIR。采用倾向评分匹配（PSM）来减少偏差。
经过1:1 PSM后，两组各有21例患者。两组在手术方式、失血量、手术时间、重建时间、术后住院时间、发病率和死亡率方面均未观察到显著差异。根据术后12个月随访时的内镜检查，两组反流性食管炎的发生率均为9.5%（2/21）。根据洛杉矶分类，隧道组无患者被分类为B级或更高等级。在评估术后3个月和6个月时的体重、白蛋白水平和预后营养指数值时，隧道组和DTJIR组患者的术后营养状况相当。
隧道吻合术是一种安全的技术，具有强大的抗反流效果，可在一些合适的PGC患者中进行。
