超级胃大部切除术:一种保留穹窿的上胃癌重建新概念

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Kohei Fujita, Hiroyuki Sagawa, Sunao Ito, Ryo Ogawa, Shuji Takiguchi
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引用次数: 0

摘要

上三分之一胃癌的发病率呈上升趋势,多数患者需要近端胃切除术或全胃切除术。然而,手术切除穹窿(胃促生长素的主要分泌部位)往往会导致术后食欲下降和体重减轻。为了解决这个问题,我们设计了一种旨在保留胃饥饿素分泌部位的切除方法。在此,我们介绍一种治疗食管胃交界附近上三分之一胃癌的新技术:超胃次全切除术(SSTG)。在机器人辅助下的远端胃切除术中,进行了淋巴结清扫。内镜下肿瘤部位的确认指导了胃切除线的设计。使用线性订书机,将胃从大曲率折叠到他的角度解剖。然后从His的角度到食管右侧通过精确切口提取标本,部分切除食管-胃交界处。缝合食管和胃的开放管腔以修复剩余的胃。膈小腿闭合可预防食管裂孔疝。通过Roux-en-Y重建实现重建。SSTG的优点是在保留穹窿的同时保持食道交界处以外的口缘。SSTG组中位手术时间333 min(范围:257 ~ 354),出血量79.5 mL(范围:20 ~ 141)。术中未见严重并发症。我们提出的SSTG技术能够保护穹窿,即使是位于食管胃交界处的上三分之一胃癌,也比以前可能的情况下。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Super Subtotal Gastrectomy: A Novel Reconstruction Concept for Upper Gastric Cancer That Preserves the Fornix

Super Subtotal Gastrectomy: A Novel Reconstruction Concept for Upper Gastric Cancer That Preserves the Fornix

The incidence of upper-third gastric cancer is rising, necessitating proximal gastrectomy or total gastrectomy in most patients. However, surgical removal of the fornix, a major site for ghrelin secretion, often results in reduced appetite and weight loss post-surgery. To address this issue, we devised a resection approach aimed at preserving ghrelin secretory sites. Here, we introduce a novel technique for treating upper-third gastric cancer near the esophagogastric junction: super subtotal gastrectomy (SSTG). During distal gastrectomy assisted by robotics, lymph node dissection was performed. Endoscopic confirmation of the tumor site guided the design of the gastrectomy line. Using a linear stapler, the stomach was dissected from the greater curvature fold to the angle of His. The specimen was then extracted through a precise incision from the angle of His to the right side of the esophagus, partially resecting the esophagogastric junction. Suturing of the open lumens of the esophagus and stomach was performed to repair the remaining stomach. Closure of the diaphragmatic crus prevented esophageal hiatal hernia. Reconstruction was achieved through Roux-en-Y reconstruction. SSTG offers the advantage of maintaining an oral margin beyond the esophageal junction while preserving the fornix. In the SSTG group, the median operative time was 333 min (range: 257–354), with a blood loss of 79.5 mL (range: 20–141). No serious intraoperative complications were observed. Our proposed SSTG technique enables the preservation of the fornix even in cases of upper-third gastric cancer located closer to the esophagogastric junction than was previously possible.

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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
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