食管癌改良管状胃手术和相关技术的研究进展

doi:10.3969/j.issn.2095-378X.2023.02.014

摘要/Abstract

摘要： 食管癌是常见的消化系统恶性肿瘤,其发病率和总死亡率在全球癌症范围内排在前列,对癌症患者具有较大的威胁。近年来,虽然我国食管癌发病率总体呈下降趋势,但仍属于食管癌高发地区,食管癌的诊治问题仍不容忽视。目前,食管癌的治疗仍是以外科为主的综合治疗模式,通过手术切除病变部位是根治食管癌的主要手段。随着外科手术技术的发展,管状胃代食管成为最常用的食管重建方式,该方式与以往的全胃代食管方式相比有着明显的优势,但仍会出现吻合口瘘、吻合口狭窄、胃食管反流等相关并发症。为了进一降低术后并发症的发生率,提高患者生活质量,大量研究对管状胃进行了革新和发展,使得管状胃技术更加的成熟和实用,同时荧光血管成像技术、机器人辅助手术技术等相关领域的改进与普及也为管状胃的发展提供了新的思路。多学科多领域的综合发展也为食管癌的ERAS方案提供了支持。本文对近年来管状胃成形术以及其改良术式的研究情况、其他相关技术的发展和应用前景进行综述。

关键词: 食管癌, 改良管状胃, 吻合口瘘, 消化道重建

Abstract: Esophageal cancer is a common malignancy of the digestive system, and its incidence rate and total mortality rate are both among the top cancers worldwide, posing a great threat to cancer patients. In recent years, despite the declining incidence, China is still a region with high incidence of esophageal cancer, and the diagnosis and treatment of esophageal cancer cannot be ignored. At present, the treatment of esophageal cancer is still a comprehensive treatment mode mainly based on surgery, and surgical resection is the main means to eradicate esophageal cancer. With the development of surgical techniques, tubular gastric esophagus has become the most commonly used method of esophageal reconstruction, and has obvious advantages over previous total gastric esophagus, but there will still be anastomotic fistula, anastomotic stenosis, gastroesophageal reflux, and other related complications. In order to reduce the incidence of postoperative complications, improve the quality of life in patients, a lot of research has been conducted on the innovation and development of tubular stomach, making tubular stomach technology more mature and practical, at the same time, fluorescence vascular imaging technology, robot-assisted surgery technology, and other related fields of improvement and popularization also provide a new idea for the development of tubular stomach. Comprehensive multidisciplinary development also provides support for the ERAS protocol for esophageal cancer. This paper reviewed the recent research of tubular gastroplasty and its modified techniques, as well as the development and application prospects of other related techniques.

Key words: Esophageal cancer, Modified gastric tube, Anastomotic leakge, Digestive tract reconstruction

中图分类号:

R735.1

滕靖琰, 张强, 尚攀, 李桂亚, 袁浩. 食管癌改良管状胃手术和相关技术的研究进展[J]. 外科研究与新技术, 2023, 12(2): 131-136.

TENG Jingyan, ZHANG Qiang, SHANG Pan, LI Guiya, YUAN Hao. Progress in modified gastric tube surgery and related techniques for esophageal cancer[J]. Surgical Research and New Technique, 2023, 12(2): 131-136.

参考文献

[1] Sung H, Ferlay J, Siegel R L, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA: Can J Clin,2021, 71(3):209-249.
[2] 刘宗超,李哲轩,张阳,等.2020全球癌症统计报告解读[J].肿瘤综合治疗电子杂志,2021,7(2):1-14.
[3] 刘宇英,魏君丽,江柔,等.食管癌的流行病学及筛查研究进展[J].中华疾病控制杂志,2022,26(7):839-844.
[4] Gisbertz SS, Hagens ERC, Ruurda JP, et al.The evolution of surgical approach for esophageal cancer[J]. Ann Ny Acad Sci, 2018, 1434(1): 149-155
[5] 李在山,张铸.管状胃在食管癌术后消化道重建中的应用[J].新疆医学,2011,41(5):57-61.
[6] Kiirschner MB.Einneuesver farend eroesophagoplastic[J]. Lan Bec Arc Chir,1920, 114(2): 606-610.
[7] Ohsawa T.Esophaseal surgery[J]. Jpnsurgsoc, 1933, 34(5): 1318-1590.
[8] 张临友,徐昊.管状胃在食管癌手术应用的临床研究进展[J].临床外科杂志,2016,24(7):552-554.
[9] Liebermann-Meffert DM, Meier R, Siewert JR.Vascular anatomy of the gastric tube used for esophageal reconstruction[N]. Ann Thorac Surg, 1992, 54(6): 1110-1115.
[10] Murakami M, Sugiyama A, Ikegami T, et al.Revascularization using the short gastric vessels of the gastric tube after subtotal esophagectomy for intrathoracic esophageal carcinoma[J]. J Am Coll Surgeons, 2000, 190(1): 71-77.
[11] 段红兵,李敏杰,康健乐.管状胃成形对预防食管癌切除术后胃食管反流的作用[J].中国胸心血管外科临床杂志,2010,17(5):417-419.
[12] 闫明, 李印, 秦建军,等.食管癌术前及术后早期胸胃排空功能的对比观察.中国肿瘤临床, 2011,38(8):452-454.
[13] 喻傲,焦子宸,王涛.食管癌术后管状胃功能研究及应用进展[J].中国胸心血管外科临床杂志,2019,26(10):1032-1037.
[14] Terashima T, Homma S, Watanabe N, et al.Motor and electrogastrographic activity of the gastric tube formed after esophagectomy[J]. J Smooth Muscle Res, 2005, 41(2):99-106.
[15] 沈祯云,王可毅,宋金涛,等.应用直线型缝合器行食管胃侧侧吻合术[J].中国现代手术学杂志,2009,13(6):434-438.
[16] Wytze Laméris, Eshuis WJ, Cuesta MA, et al.Optimal mobilization of the stomach and the best place in the gastric tube for intrathoracic anastomosis[J]. J Thorac Dis, 2019, 11(S5):S743-S749.
[17] Fabian T.Management of postoperative complications after esophageal resection[J]. Surg Clin N Am,2021,101(3):525-539.
[18] 高新芳,赵国强,宋宣统.改良管状胃在胸中、上段食管癌手术中的应用[J].临床医学,2011,31(8):57-58.
[19] 卢温民,郭占领,李书清,等.改良管状胃和管状胃代食管对食管胸中下段癌患者手术治疗效果的比较研究[J].中国胸心血管外科临床杂志,2015,22(9):855-858.
[20] Liu B, Wang W, Liang T.Clinical observation of modified gastric tube in middle and lower thoracic esophageal carcinoma surgery[J]. J Car Surg, 2019, 14(1): 56-65.
[21] 韩飞,戴天阳,何开明,等.改良管状胃代食管在开放手术治疗食管胸中下段癌中应用的短期效果[J].中国临床研究,2019,32(2):239-243.
[22] Wang Z, Zhang H, Wang F, et al.Robot-assisted esophagogastric reconstruction in minimally invasive Ivor Lewis esophagectomy[J]. J Thorac Dis, 2019, 11(5): 1860-1866.
[23] Junemann-Ramirez M, Awan MY, Khan ZM, et al.Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre.[J]. Eur J Cardiothorac Surg, 2005, 27(1):3-7.
[24] Shimakawa T, Naritaka Y, Asaka S, et al.Innovations for cervical esophagogastrostomy in thoracic esophageal cancer operations[J]. Anticancer Res, 2018, 38(4): 2323-2327.
[25] Nakajima Y, Kawada K, Tokairin Y, et al.Flexible gastric tube: a novel gastric tube formation method to prevent anastomotic leakage[J]. Ann Thorac Surg, 2020, 109(6): e445-e447.
[26] 肖鑫,栾思源,杨玉赏,等. 锥形管状胃联合颈部端端分层吻合在胸腹腔镜食管癌切除术中的应用价值[J]. 中华消化外科杂志, 2019,18(6):542-548.
[27] 原锋锋,张岩,邱龙,等. 梭形管状胃在胸腹腔镜联合食管癌根治术消化道重建中的应用价值[J]. 中华消化外科杂志,2018,17(8):810-816.
[28] Lai Y, Ye X, Wang X, Hu Y.The influence of anastomosis-induced gastric wall defects on the blood supply to the gastric tube[J]. Thorac Cardiovasc Surg, 2020, 159(4): e281-e284.
[29] 姚玉军,王志强,朱冈.改良管状胃在胸腹腔镜食管癌根治术后预防吻合口瘘发生的临床观察[J].现代诊断与治疗,2021,32(12):1907-1908.
[30] 施庆彤,范黄新,刁亚利.管状胃宽度与食管癌术后抗胃食管反流的临床研究[J].中华胸部外科电子杂志,2016,3(1):25-28.
[31] 何家贤,陈桂荣,黄俊,等.管状胃宽度与食管癌术后抗胃食管反流的相关性研究[J].局解手术学杂志,2017,26(3):197-200.
[32] 葛姣姣,马可,王帅,等.不同宽度管状胃对食管癌切除术后患者生活质量的影响:一项倾向配比研究[J].中国临床医学,2021,28(1):16-22.
[33] 何晓峰,史敏科,曹彬.管状胃在食管癌切除术中的应用进展[J].中国胸心血管外科临床杂志,2016,23(2):187-190.
[34] Barbera M, Pietro MD, Walker E, et al.The human squamous oesophagus has widespread capacity for clonal expansion from cells at diverse stages of differentiation[J]. Gut, 2015, 64(1): 11-19.
[35] Kumagai Y, Ishiguro T, Sobajima J, et al.Factors affecting blood flow at the tip of the reconstructed gastric tube during esophagectomy: A study using indocyanine green fluorescence angiography[J]. Int Surg, 2016, 101(7): 381-389.
[36] 周彬,张亚杰,李鹤成. 机器人辅助Ivor-Lewis食管癌切除术研究进展[J]. 中国胸心血管外科临床杂志, 2018, 25(7):616-621
[37] Ohi M, Toiyama Y, Mohri Y, et al.Prevalence of anastomotic leak and the impact of indocyanine green fluorescein imaging for evaluating blood flow in the gastric conduit following esophageal cancer surgery[J]. Esophagus, 2017, 14(4): 351-359
[38] Panchal SJ, Kushnerik V.Multimodal approaches to improve surgical outcome[J]. Tec Reg An & Pain Man, 2002, 6(2):70-76.
[39] Sun HB, Li Y, Liu XB, et al.Early oral feeding following McKeown minimally invasive esophagectomy: An open-label, randomized, controlled, noninferiority trial[J]. Ann Surg, 2017, 267(3): 435-442.
[40] 喻傲,焦子宸,王涛.食管癌术后管状胃功能研究及应用进展[J].中国胸心血管外科临床杂志, 2019, 26(10): 1032-1037.