Application of hybrid transhiatal tunnel valvuloplasty following laparoscopic proximal gastrectomy
10.3760/cma.j.cn113855-20240814-00535
- VernacularTitle:经纵隔隧道瓣成型法在腹腔镜近端胃切除术后消化道重建中的应用
- Author:
Chunguang GUO
1
;
Yong LIU
;
Dong QU
;
Hu REN
;
Zefeng LI
;
Chongyuan SUN
;
Xiaojie ZHANG
;
He FEI
;
Guiqi WANG
;
Dongbing ZHAO
Author Information
1. 国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院胰胃外科，北京 100021
- Publication Type:Journal Article
- Keywords:
Stomach neoplasms;
Gastrectomy;
Esophgogastrostomy
- From:
Chinese Journal of General Surgery
2025;40(1):42-46
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate a transhiatal tunnel flap designed to reconstruct the cardiac functional structure in proximal gastric cancer patients in our center.Methods:A descriptive case study method was used to select the data of 11 patients undergoing surgery for upper gastric cancer from Jan to Jul 2024. After laparoscopic dissection is completed, the esophagus is transected 2 cm from the upper edge of the tumor and the specimen is removed. The distance from the lower edge of the tumor is 5 cm. The cutting width is 4 cm, and the length of sleeve distal stump stomach is 20 cm. A seromuscular flap tunnel was made with a length of 2 cm and a width of 2 cm, 2 cm away from the top of the remnant stomach. The digestive tract was reconstructed using the Overlap hybridization method.Results:The median operation time was 175 (139-285) minutes. The median muscle flap production time and reconstruction time was 10.5 (5.5-21.0) minutes and 15.0 (11.8-33.6) minutes, respectively. The median blood loss is 50 (20-100) ml. The median postoperative hospitalization was 8 (6-25) days. The median tumor size was 2.5 (1.0-4.0) cm, and 31 (15-52) lymph nodes were dissected. The median follow-up after surgery was 3.5 (0.7-6.0) months, and no tumor recurrence or metastasis was found. Postoperative anastomotic leakage (Clavien-Dindo grade Ⅱ) occurred in one case, and there was no perioperative death. The Visick score of the whole group was 1 point in 8 cases and 2 points in 3 cases, and there was no anastomotic stenosis. Reflux esophagitis (Los Angeles classification grade B) was found in 1 case after gastroscopy, and the symptoms were relieved by conservative treatment.Conclusion:The transhiatal tunnel flap arthroplasty method has high surgical safety, low reconstruction difficulty, and an reliable anti-reflux effect.
