Huang Jiarong, Dong Zhebin, Chen Fangqian, Xiang Hanting, Chen Tianci, Sun Tianyuan, Chen Sangsang, Cai Xianlei, Liang Chao, Yu Weiming
Department of General Surgery, The Affiliated LiHuiLi Hospital of NingBo University, Ningbo, 315000, Zhejiang, China.
Surg Endosc. 2025 May;39(5):2973-2981. doi: 10.1007/s00464-025-11660-1. Epub 2025 Mar 21.
Dysphagia is a common complication after total gastrectomy and esophagojejunostomy for gastric cancer. Dysphagia leads to impaired quality of life in the short- and long-term postoperative period and affects patient prognosis. The reasons for the occurrence of dysphagia have been controversial, for which we provide new insights. We compared the effects of different jejunal positions on the incidence of postoperative dysphagia in patients with gastric cancer.
A total of 116 patients who underwent radical total gastrectomy and esophagojejunostomy for gastric cancer were included. The patients were divided into 2 groups: right esophagojejunostomy (REJ) and left esophagojejunostomy (LEJ). Clinical and pathologic characteristics, incidence of postoperative dysphagia and other surgical complications were compared between the two groups.
After grouping the patients, there were 60 patients in the REJ group and 56 patients in the LEJ group. The incidence of postoperative dysphagia was higher in the REJ group than in the LEJ group (p = 0.035) 17 (28.3%) and 7 (12.5%) respectively. Anastomotic stenosis occurred in one patient in the REJ group, and displacement of the jejunum occurred in six patients after imaging, and two of them underwent secondary surgical treatment to severe dysphagia, which was not found in the LEJ group. Multivariate logistic regression analysis showed that LEJ was an independent protective factor for dysphagia and anastomotic fistula was an independent risk factor for dysphagia (P < 0.05). The jejunal position had the greatest impact on dysphagia.
LEJ can effectively reduce the incidence of dysphagia in gastric cancer patients after esophagojejunostomy. Clinical and follow-up outcomes demonstrate the superiority of the LEJ reconstruction method in the treatment of TG and EJ.
吞咽困难是胃癌全胃切除及食管空肠吻合术后常见的并发症。吞咽困难会导致术后短期和长期生活质量受损，并影响患者预后。吞咽困难发生的原因一直存在争议，我们对此提供了新的见解。我们比较了不同空肠位置对胃癌患者术后吞咽困难发生率的影响。
共纳入116例行胃癌根治性全胃切除及食管空肠吻合术的患者。患者分为2组：右食管空肠吻合术（REJ）组和左食管空肠吻合术（LEJ）组。比较两组患者的临床和病理特征、术后吞咽困难发生率及其他手术并发症。
分组后，REJ组有60例患者，LEJ组有56例患者。REJ组术后吞咽困难发生率高于LEJ组（p = 0.035），分别为17例（28.3%）和7例（12.5%）。REJ组有1例患者发生吻合口狭窄，6例患者影像学检查发现空肠移位，其中2例因严重吞咽困难接受了二次手术治疗，LEJ组未发现此类情况。多因素logistic回归分析显示，LEJ是吞咽困难的独立保护因素，吻合口瘘是吞咽困难的独立危险因素（P < 0.05）。空肠位置对吞咽困难的影响最大。
LEJ可有效降低胃癌患者食管空肠吻合术后吞咽困难的发生率。临床及随访结果表明LEJ重建方法在治疗全胃切除及食管空肠吻合术中具有优越性。
