Application of Dual-Channel Anastomosis of Residual Stomach and Jejunum in Radical Resection of Upper Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Jianqiang , GUAN Xiaoqing , WU Jisheng , CHEN Yan , HUANG Hailong , WANG Jian , ZHENG Xiangxin.

Department of General Surgery, People’s Hospital of Suqian City, Suqian 223800, Jiangsu Province, China;

Corresponding author：

Keywords：

Upper gastric tumor; Dual-channel anastomosis; Digestive tract reconstruction; Gastroesophageal reflux syndrome

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Objective To explore the value of dual-channel anastomosis of residual stomach and jejunum in radical resection of the upper gastric cancer.
Methods Forty patients with upper gastric cancer had undergone proximal gastrectomy and dualchannel digestive tract reconstruction, including esophagus-jejunum side to side anastomosis, residual stomachjejunum anastomosis, and jejunum-jejunum anastomosis.
Results The cutting margin away from tumor in all the cases was more than 5 cm and no carcinoma residual. The number of lymph nodes dissection was 21±6, reaching the requirement of D2 radical surgery. There was no case appearing complications such as anastomotic leakage, obstruction or bleeding. Barium meal examination after operation showed that most of barium was directly into the jejunum, the remaining went through the duodenum into the jejunum without gastroesophageal reflux. Followed up 6-30 months with average 18 months, there were no visible reflux esophagitis in all the cases, and only 1 case appeared minor dumping syndrome. The hemoglobin increased and the quality of life was satisfactory after operation.
Conclusions In regard to dual-channel anastomosis of residual stomach and jejunum, resection range is reasonable, dissection scope accords with the protocol and residual stomach has a certain pouch effect. The anastomosis has a favorable prevention from reflux esophagitis and dumping syndrome and retains the duodenum pathway, so that improves the quality of patients’ life and is a relatively ideal digestive tract reconstruction.

Citation： WU Jianqiang,GUAN Xiaoqing,WU Jisheng,CHEN Yan,HUANG Hailong,WANG Jian,ZHENG Xiangxin.. Application of Dual-Channel Anastomosis of Residual Stomach and Jejunum in Radical Resection of Upper Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(9): 963-966. doi: Copy

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21.	肖仕明, 姜淮芜, 吴宸, 等. 根治性近端胃切除术后的两种重建术式评价 [J].中国普外基础与临床杂志, 2008; 15(9): 682685.
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23.	黎介寿. 肠内营养-外科临床营养支持的首选途径 [J].中国实用外科杂志, 2003; 23(1): 67.
24.	罗世成, 郭建辉, 朱军, 等. 胃肠道肿瘤患者术后早期肠内营养与肠外营养支持的随机对照研究 [J] . 中国普外基础与临床杂志, 2007; 14(3): 324328.
25.	蒋朱明, 蔡威. 临床肠外与肠内营养 [M]. 北京: 科学技术出版社, 2001: 208209.

1. 汤睿, 朱正刚. 胃癌全胃切除消化道重建术式临床研究进展 [J]. 国外医学消化系统疾病分册, 2005; 25(3): 12051209.
2. 陈峻青. 日本胃癌处理规约第13版重要修改内容简介 [J]. 中国实用外科杂志, 2000; 20(1): 6062.
3. Paimela H, Ketola S, Iivonen M, et al. Longterm results after surgery for gastric cancer with or without jejunal reservoir: results of surgery for gastric cancer in KantaHme central hospital in two consecutive periods without or with jejunal pouch reconstruction in 19851998 [J]. Int J Gastrointest Cancer, 2005; 36(3): 147153.
4. Berardi R, Scartozzi M, Romagnoli E, et al. Gastric cancer treatment: a systematic review [J]. Oncol Rep, 2004; 11(4): 911916.
5. 张启瑜. 钱礼腹部外科学 [M]. 北京: 人民卫生出版社, 2006: 237266.
6. 陈峻青. 正确选择胃癌胃切除的重建术 [J]. 中华胃肠外科杂志, 2001; 4(1): 56.
7. 陈峻青. 胃癌外科基础研究与扩大切除术的进展 [J]. 中国普外基础与临床杂志, 2004; 11(2): 9799.
8. 陈佳平. 胃癌术后复发的诊断与治疗 [J]. 中国普外基础与临床杂志, 2004; 11(2): 104106.
9. Edwards P, Blackshaw GR, Lewis WG, et al. Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma [J]. Br J Cancer, 2004; 90(10): 18881892.
10. 胡建昆, 陈志新, 张波, 等. 胃癌根治术中No.8淋巴结清扫的意义和技巧 [J]. 中国普外基础与临床杂志, 2007; 14(5): 560563.
11. Smith BR, Stabile BE. Aggressive D2 lymphadenectomy is required for accurate pathologic staging of gastric adenocarcinoma [J]. Am Surg, 2006; 72(10): 849852.
12. Park SS, Park JM, Kim JH, et al. Prognostic factors for patients with nodenegative gastric cancer: Can extended lymph node dissection have a survival benefit? [J]. J Surg Oncol, 2006; 94(1): 1620.
13. 郝希山, 李强, 张中国. 胃癌患者全胃切除术后消化道重建方式的临床研究 [J]. 中华胃肠外科杂志, 2003; 6(2): 8992.
14. 卢辉山, 张建中, 吴心愿, 等. 全胃切除术后消化道重建的前瞻性随机对照研究 [J]. 中华肿瘤杂志, 2003; 25(3): 255257.
15. 尚占民, 高岩, 关玉盘, 等. 食管裂孔疝患者食管蠕动功能的变化 [J]. 中华消化内镜杂志, 2002; 19(3): 159161.
16. 李兆申, 王雯, 许国铭, 等. 反流性食管炎1 827例临床分析 [J]. 中华内科杂志, 2001; 40(1): 912.
17. 姜佳丽, 王虹, 王敏丽, 等. 反流性食管炎的临床研究 [J]. 中华内科杂志, 2002; 41(12): 822824.
18. Hoshikawa T, Denno R, Ura H, et al. Proximal gastrectomy and jejunal pouch interposition: evaluation of postoperative symptoms and gastrointestinal hormone secretion [J]. Oncol Rep, 2001; 8(6): 12931299.
19. Heimbucher J, Fuchs KH, Freys SM, et al. Motility in the HuntLawrence pouch after total gastrectomy [J]. Am J Surg, 1994; 168(6): 622625.
20. 程应东, 单志堂, 周培建, 等. 全胃切除术消化道重建方式的探讨 [J]. 中国普通外科杂志, 2004; 13(1): 4446.
21. 肖仕明, 姜淮芜, 吴宸, 等. 根治性近端胃切除术后的两种重建术式评价 [J].中国普外基础与临床杂志, 2008; 15(9): 682685.
22. 王湘辉, 王海忠, 吕志诚. 近端胃大部切除术后两种消化道重建术式的比较 [J]. 临床肿瘤学杂志, 2007; 12(9): 681683.
23. 黎介寿. 肠内营养-外科临床营养支持的首选途径 [J].中国实用外科杂志, 2003; 23(1): 67.
24. 罗世成, 郭建辉, 朱军, 等. 胃肠道肿瘤患者术后早期肠内营养与肠外营养支持的随机对照研究 [J] . 中国普外基础与临床杂志, 2007; 14(3): 324328.
25. 蒋朱明, 蔡威. 临床肠外与肠内营养 [M]. 北京: 科学技术出版社, 2001: 208209.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Dual-Channel Anastomosis of Residual Stomach and Jejunum in Radical Resection of Upper Gastric Cancer

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