PRESERVATION OF THE LOWER ESOPHAGEAL SPHINCTER DURING TOTAL GASTRECTOMY FOR GASTRIC-CANCER TO PREVENT POSTOPERATIVE REFLUX ESOPHAGITIS

被引：13

作者：

HIRAI, T

SAEKI, S

MATSUKI, K

YAMASHITA, Y

IWATA, T

YOSHIMOTO, A

TOGE, T

机构：

[1] Department of Surgical Oncology, Division of Clinical Research, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, 734, 1-2-3 Kasumi, Minami-ku

来源：

SURGERY TODAY-THE JAPANESE JOURNAL OF SURGERY | 1995年 / 25卷 / 06期

关键词：

GASTRIC CANCER; TOTAL GASTRECTOMY; LOWER ESOPHAGEAL SPHINCTER; REFLUX ESOPHAGITIS;

D O I：

10.1007/BF00311306

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

The lower esophageal sphincter (LES) is usually removed during total gastrectomy to successfully perform a curative operation. In this study, the preservation of the LES in curative total gastrectomy was attempted to reduce the reflux. An experimental study using dogs has revealed that the high-pressure zone of the LES can be preserved by making a resection at the gastroesophageal junction, which thus helps to protect the reflux. A previous clinicopathological study revealed that the LES can be preserved without any fear of recurrence at the resection site, if the tumor is located more than 2.0 cm and 3.0 cm from the gastroesophageal junction to the oral margin in node-negative and -positive cases, respectively. Clinically, 8 patients underwent an LES-preserving total gastrectomy [LES(+) gastrectomyl while 19 had an LES(-) gastrectomy in the same period. Of the five LES(+) cases examined, all showed a high pressure zone, whereas none of the four LES(-) cases examined showed such a high-pressure zone after the operation. Endoscopic examination showed that only one of the seven LES(+) cases but six of nine LES(-) cases revealed esophagitis.

引用

页码：507 / 514

页数：8

共 13 条

[1]

Hirai T., Aratani S., Yoshinaka K., Toge T., Niimoto M., Hattori T., Clinical studies on the complaints of survivors living more than 3 months after total gastrectomy, Jpn J Cancer Clin, 33, pp. 258-264, (1987)

[2]

Plenk A., Ligatur des jejunum zur Vermeidung Galleruckflusses nach E-S-Anastomose des Oesophagus mit ungeteilter Jejunumschlinge bei totaler Gastrektomie, Wiener Med Wschr, 107, pp. 956-957, (1957)

[3]

Jamieson G.G., Duranceau A.G., The investigation and classification of reflux disease, Surgery of the oesophagus, pp. 201-211, (1988)

[4]

Domjan L., Simon L., Alkaline reflux esophagitis in gastroresected patients, Scand J Gastroenterol, 19, pp. 245-249, (1984)

[5]

Salo J.A., Kivilaakso E., Failure of long limb Roux-en-Y reconstruction to prevent alkaline reflux esophagitis after total gastrectomy, Endoscopy, 22, pp. 65-67, (1990)

[6]

Watanabe M., Nishinari N., Nakamura R., Kondo S., Abe T., Asahi H., Sato M., Sugimura Y., Kikuchi M., Mori S., Pathogenesis and treatment of reflux esophagitis after various gastric resections, The Japanese Journal of Gastroenterological Surgery, 19, pp. 2142-2145, (1986)

[7]

Sakamoto T., Fumoto K., Yamada A., Shimazaki K., Suzuki Y., Shinbo T., Karaki Y., Saitoh J., Tazawa K., Itoh H., Fujimaki M., The role of the ileocecal valve function preventing reflux esophagitis with special reference to total or proximal gastrectomy, Nihon Kikan Shokudoka Gakkai Kaiho, 35, pp. 293-298, (1984)

[8]

Nishiwaki T., Saji S., Minatsu H., Ohnishi A., Kunieda K., Miya K., Fukada D., Azuma S., Tanemura H., Furuta T., Sakata K., Tanaka S., Itou T., Clinical evaluation of a modified p-Graham operation for total gastrectomy — with special reference to manometry, J Jpn Soc Clin Surg, 48, pp. 751-758, (1987)

[9]

Wienbeck M., Li Q., Cisapride in gastro-oesophageal reflux disease: effects on oesophageal motility and intraoesophageal pH, Scand J Gastroenterol, 24, pp. 13-18, (1989)

[10]

Strombeck D.R., Harrold D., Ferrier W., Eructation of gas through the gastroesophageal sphincter before and after truncal vagotomy in dogs, Am J Vet Res, 48, pp. 207-210, (1987)

← 1 2 →