Noguchi T, Uchida Y, Hashimoto T, Takeno S, Tohara K, Kubo N
Department of Surgery II, Oita Medical University, Japan.
Nihon Geka Gakkai Zasshi. 1998 Sep;99(9):569-74.
In order to reduce the incidence of reflux esophagitis following proximal gastrectomy, we have developed a new reconstruction procedure with an interposed jejunal pouch with antireflux valvuloplasty between the esophagus and the gastric remnant. After a standard proximal gastrectomy and lymph node dissection, the jejunum is divided at a point 25 cm from the Treitz ligament. The distal jejunum is pulled up through the transverse mesocolon with a mesenterium and anastomosed to the esophagus with a PCEEA stapling device. The pulled through jejunum is doubled up at a point 30 cm from the esophagojejunostomy, and the 5 cm tip of the jejunum is resected. A 5.5 cm autosuture GIA is inserted into the jejunum from both cut ends of the jejunum for side-to-side anastomosis on the antimesenteric side to make a 5 cm long jejunal pouch, and the jejunum is further divided 5 cm distal from the jejunal pouch. As a result, the interposed jejunal segment is omponed of a single-lumen 15 cm jejunum, a parallel lumen 5 cm jejunum, and a double-lumen jejunum. In the double-lumen jejunum, the jejunal pouch plays the role of a pressure absorber in the residual stomach, and the septum of the parallel lumen jejunum that of an anti-reflux valve. Peristalsis of the single lumen 15 cm jejunum prevents reflux to the esophagus. Postoperative examinations showed that this reconstruction method has satisfactory to excellent results.
为降低近端胃切除术后反流性食管炎的发生率，我们研发了一种新的重建术式，即在食管与胃残端之间置入带抗反流瓣膜成形术的空肠袋。在进行标准的近端胃切除及淋巴结清扫术后，于距屈氏韧带25 cm处切断空肠。将远端空肠经横结肠系膜带系膜上提，用PCEEA吻合器与食管吻合。上提的空肠在距食管空肠吻合口30 cm处折返，切除5 cm长的空肠末端。从空肠的两个断端向空肠内插入5.5 cm的自动缝合GIA，在系膜对侧进行侧侧吻合，形成一个5 cm长的空肠袋，然后在空肠袋远端5 cm处进一步切断空肠。结果，置入的空肠段由一段15 cm单腔空肠、一段5 cm平行腔空肠和一段双腔空肠组成。在双腔空肠中，空肠袋起到残余胃内压力缓冲器的作用，平行腔空肠的隔膜起到抗反流瓣膜的作用。15 cm单腔空肠的蠕动可防止反流至食管。术后检查表明，这种重建方法的效果令人满意甚至极佳。
