장막 침윤이 없는 위암에서 하부 식도조임근 보존 전체위절제술 후 공장낭 간치술

• Published in: Annals of surgical treatment and research pp. 290 - 297
• Main Authors: 김동진, 허훈, 전해명, 김욱
• Format: Journal Article
• Language: Korean
• Published: 대한외과학회 01.05.2010
• Subjects: 일반외과학
• ISSN: 2288-6575; 2288-6796

Purpose: Conventional total gastrectomy with Roux-en-Y esophagojejunostomy has certain limitations such as insufficient food reservoir and malabsorption of nutrients. Therefore, we performed reconstruction of the jejunal pouch interposition (JPI) after near-total gastrectomy preserving the lower esophageal sphincter (LES). We compared the technical feasibility, safety, and surgical outcome of this operation with conventional total gastrectomy accompanying with Roux-en-Y esophagojejunostomy. Methods: From April 2003 to October 2005, 15 LES-preserving, near-total gastrectomies with JPI (LES-JPI group) were performed. The clinical features and surgical outcomes were retrospectively compared with 17 cases of conventional R-Y esophagojejunostomy. Statistical analysis was performed using Fisher’s exact test for categorical data and an unpaired t-test for continuous data. Results: Clinicopathological features of the LES-JPI and R-Y groups did not show differences excepting patient age (50.8±5.8 years vs. 62.8±12.4, respectively; P=0.002) and the depth of tumor invasion (T1-T2; 11∼4 vs. 5∼12; P=0.032). The operative outcomes for the two groups significantly differed in terms of operation time (676 vs. 484 min; P=0.008) and blood loss (424 vs. 336 ml; P=0.006). Postoperative gastrofiberscopic examination of all LES-JPI patients showed no esophageal reflux or strictures and intact LES. In addition, the LES-JPI group did not experience swallowing difficulty or stricture. Conclusion: LES-preserving total gastrectomy with JPI is a feasible and safe procedure for patients with upper gastric cancer. Purpose: Conventional total gastrectomy with Roux-en-Y esophagojejunostomy has certain limitations such as insufficient food reservoir and malabsorption of nutrients. Therefore, we performed reconstruction of the jejunal pouch interposition (JPI) after near-total gastrectomy preserving the lower esophageal sphincter (LES). We compared the technical feasibility, safety, and surgical outcome of this operation with conventional total gastrectomy accompanying with Roux-en-Y esophagojejunostomy. Methods: From April 2003 to October 2005, 15 LES-preserving, near-total gastrectomies with JPI (LES-JPI group) were performed. The clinical features and surgical outcomes were retrospectively compared with 17 cases of conventional R-Y esophagojejunostomy. Statistical analysis was performed using Fisher’s exact test for categorical data and an unpaired t-test for continuous data. Results: Clinicopathological features of the LES-JPI and R-Y groups did not show differences excepting patient age (50.8±5.8 years vs. 62.8±12.4, respectively; P=0.002) and the depth of tumor invasion (T1-T2; 11∼4 vs. 5∼12; P=0.032). The operative outcomes for the two groups significantly differed in terms of operation time (676 vs. 484 min; P=0.008) and blood loss (424 vs. 336 ml; P=0.006). Postoperative gastrofiberscopic examination of all LES-JPI patients showed no esophageal reflux or strictures and intact LES. In addition, the LES-JPI group did not experience swallowing difficulty or stricture. Conclusion: LES-preserving total gastrectomy with JPI is a feasible and safe procedure for patients with upper gastric cancer. KCI Citation Count: 2