Kuwabara Shirou, Kobayashi Kazuaki, Sudo Natsuru, Nobuhiro Masanori, Tashiro Ai
Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata Prefecture, 950-1197, Japan.
Updates Surg. 2025 Jun;77(3):867-877. doi: 10.1007/s13304-025-02196-z. Epub 2025 Apr 3.
While the stomach is commonly used as an esophageal substitute after esophagectomy, it may not be a viable option in some cases. One alternative for esophageal reconstruction is a pedunculated gastric tube with distal partial gastrectomy (PGT-DPG). However, no studies have comprehensively analyzed its efficacy. We retrospectively evaluated the clinical characteristics and surgical outcomes of patients who underwent PGT-DPG between 2011 and 2023, and reviewed previously published studies on the surgical outcomes of PGT-DPG. Among the nine patients in the current study, seven underwent PGT-DPG for gastric cancer; of which, five were performed concurrently with esophagectomy, while two were conducted following prior esophagectomy. Additionally, PGT-DPG was performed in two cases with benign gastric lesions. The major postoperative complications included pneumonia (two cases), anastomotic leakage (two cases), and recurrent laryngeal nerve paralysis (one case). No graft necrosis or mortality was observed. Our review of these cases, along with previously reported cases, indicated that PGT-DPG showed efficacy due to its availability for antral early gastric cancer, avoidance of bowel reconstruction, simplified technique, and improved cervical elevation. PGT-DPG is a valuable rescue option in cases in which gastric tube reconstruction is challenging. Therefore, esophageal surgeons should be well acquainted with this technique.
虽然胃在食管切除术后常被用作食管替代物，但在某些情况下可能不是一个可行的选择。食管重建的一种替代方法是带蒂胃管加远端部分胃切除术（PGT-DPG）。然而，尚无研究对其疗效进行全面分析。我们回顾性评估了2011年至2023年间接受PGT-DPG治疗的患者的临床特征和手术结果，并回顾了先前发表的关于PGT-DPG手术结果的研究。在本研究的9例患者中，7例因胃癌接受PGT-DPG治疗；其中，5例与食管切除术同时进行，2例在先前食管切除术后进行。此外，2例良性胃病变患者接受了PGT-DPG治疗。主要术后并发症包括肺炎（2例）、吻合口漏（2例）和喉返神经麻痹（1例）。未观察到移植物坏死或死亡。我们对这些病例以及先前报道的病例进行回顾表明，PGT-DPG因其可用于胃窦早期胃癌、避免肠道重建、技术简化和提高颈部抬高而显示出疗效。PGT-DPG在胃管重建具有挑战性的病例中是一种有价值的挽救选择。因此，食管外科医生应熟悉这项技术。
