Методы реконструкции желудочно-кишечного тракта после гастрэктомии по поводу рака желудка

Pак желудка (РЖ) занимает третье место по смертности в мировой структуре онкологических заболеваний. Несомненно, оперативный метод является приоритетным в лечении РЖ. История развития, становления и совершенствования хирургии РЖ насчитывает уже почти 140 лет. За это время приоритетным направлением многочисленных исследований являлась разработка наиболее надежного и физиологичного метода реконструкции после гастрэктомии (ГЭ). На сегодняшний день в литературе описано более 70 различных вариантов реконструкции после ГЭ, многие из которых применяются и на практике. Глобально можно выделить два основных типа реконструктивных этапов (РЭ) после ГЭ: без сохранения и с сохранением пассажа по двенадцатиперстной кишке (ДПК). Преимущества и недостатки этих РЭ после ГЭ продолжают оставаться предметом жарких дискуссий среди хирургов, так как исследования непосредственных и отдаленных результатов различных вариантов этих операций крайне противоречивы. Мы постарались проследить основные вехи развития РЭ после ГЭ, а так же провели обзор литературы с целью выявления наиболее оптимального и физиологичного хирургического метода реконструкции у пациентов с раком желудка (РЖ) после гастрэктомии.

1. Schlatter C. A. A unique case of complete removal of the stomach– Successful esophagoenterostomy recovery. Le Médecin de Réserve. 1897;52:909–914 https://doi.org/10.1038/scientificamerican01151898–18387supp

2. Nebojsa S. I., Tomislav D. R., Miroslav P. S., Goran Z. S. Miodrag N. D. Reconstructive Procedures after Total Gastrectomy for Gastric Cancer http://dx.doi.org/10.5772/intechopen.75591

3. Lemmon WT, Paschal GW. Total gastrectomy for carcinoma of the stomach. Annals of Surgery. 1940;112:31–36. https://doi.org/10.1097/00000658–194007000–00004

4. Lawrence WJ. Reconstruction after total gastrectomy: What is preferred technique? Journal of Surgical Oncology. 1996;63:215–220. https://doi.org/10.1002/(SICI)1096–9098(199612)63:4%3C215::AIDJSO1%3E3.0.CO;2-F

5. Wu LL, Liang H, Zhang RP, Pan Y, Wang BG. Comparative study on four different reconstruction procedures after total gastrectomy. Zhonghua Wei Chang Wai Ke Za Zhi. 2010;13:895–898.

6. Piessen G, Triboulet JP, Mariette C. Reconstruction after gastrectomy: Which technique is best? Journal of Visceral Surgery. 2010;147:273–283. https://doi.org/10.1016/j.jviscsurg.2010.09.004

7. Ikard RW. Collective reviews. The Y anastomoses of César Roux. Surgery, Gynecology & Obstetrics. 1989;169:559–567.

8. Reid MR. Total gastrectomy. Surgery, Gynecology & Obstetrics. 1925;41:667–672.

9. Orr TG. A modified technique for total gastrectomy. Archives of Surgery. 1947;54:279–286. https://doi.org/10.1001/archsurg.1947.01230070285003

10. Юдин С. С. Этюды желудочной хирургии. М. 1955. Yudin S. S. Etudes of gastric surgery. Moscow. 1955. (In Russ.)

11. Liedman B, Andersson H, Berglund B. Food intake after gastrectomy for gastric carcinoma: Th e role of a gastric reservoir. Th e British Journal of Surgery. 1996;83:1138– 1143. https://doi.org/10.1002/bjs.1800830835

12. Wells C, Johnston JH. Revision to the Roux-en-Y anastomosis for post-gastrectomy syndromes. Lancet. 1956;2:479–481. https://doi.org/10.1016/s0140–6736(56)91969–9

13. Hunt CJ. Construction of food pouch from segment of jejunum as substitute for stomach in total gastrectomy. A.M.A. Archives of Surgery. 1952;64:601–608. https://doi.org/10.1001/archsurg.1952.01260020013001

14. Lawrence WJ. Reservoir construction after total gastrectomy: An instructive case. Annals of Surgery. 1962;155:191–198. https://doi.org/10.1097/00000658–196200000–00004

15. Nakane Y, Okumura S, Akehira K. Jejunal pouch reconstruction after total gastrectomy for cancer. A randomized controlled trial. Annals of Surgery. 1995;222:27–35. https://doi.org/10.1097/00000658–199507000–00005

16. Liedman B, Bosaeus I, Hugosson I. Long-term beneficial effects of a gastric reservoir on weight control after total gastrectomy: A study of potential mechanisms. Th e British Journal of Surgery. 1998;85:542–547. https://doi.org/10.1046/j.1365–2168.1998.00747.x

17. Horvath OP, Kalmar K, Cseke L. Nutritional and life-quality consequences of aboral pouch construction after total gastrectomy: A randomized, controlled study. European Journal of Surgical Oncology. 2001;27:558–563. https://doi.org/10.1053/ejso.2001.1172

18. Zong L, Chen P, Chen Y, Shi G. Pouch Roux-en-Y vs No Pouch Roux-en-Y following total gastrectomy: a meta-analysis based on 12 studies. J Biomed Res. 2011;25(2):90–99. https://doi.org/10.1016/s1674–8301(11)60011–0

19. Schmitz R, Moser KH, Treckmann J. Quality of life after prograde jejunum interposition with and without pouch. A prospective study of stomach cancer patients on the reservoir as a reconstruction principle after total gastrectomy. Chirurg 1994;65:326

20. Ishigami S., Aridome K., Nakajo A., et al. Roux-en-Y reconstruction with stapled distal jejunal pouch after total gastrectomy. Am Surg. 2010;76:526–8. https://doi.org/10.1177/000313481007600523

21. Fujiwara Y, Kusunoki M, Nakagawa K, Tanaka T, Hatada T, Yamamura T. Evaluation of J-pouch reconstruction after total gastrectomy: ρ-double tract vs. J-pouch double tract. Digestive Surgery. 2000;17:475–482. https://doi.org/10.1159/000051943

22. Bozzetti F, Bonfanti G, Castellani R, et al. Comparing reconstruction with Roux-en-Y to a pouch following total gastrectomy. Journal of the American College of Surgeons 1996;183:243–8

23. Svedlund J, Sullivan M, Liedman B, Lundell L, Sjodin I. Quality of life after gastrectomy for gastric carcinoma: controlled study of reconstructive procedures. World Journal of Surgery 1997;21:422–33

24. Takeshita K, Sekita Y, Tani M. Medium- and long-term results of jejunal pouch reconstruction after a total and proximal gastrectomy. Surg Today 2007;37:754–61. https://doi.org/10.1007/s00595–007–3497–5

25. Noh SM. Improvement of the Roux limb function using a new type of ‘uncut Roux’ limb. Am J Surg 2000;180:37– 40. https://doi.org/10.1016/s0002–9610(00)00421–9

26. Jangjoo A, Mehrabi Bahar M, Aliakbarian M. Uncut Roux-en-Y esophagojejunostomy: a new reconstruction technique after total gastrectomy. Indian J Surg 2010;72:236–9. https://doi.org/10.1007/s12262–010–0059–7

27. Zhou Y, Wang F, Ji Y, Lv J. A CARE-compliant article: a case of retrograde intussusception with Uncut-Rouxen-Y anastomosis after radical total gastrectomy: Review of the literature. Medicine (Baltimore). 2017;96(48): e8982. https://doi.org/10.1097/md.0000000000008982

28. Kajitani K, Sato J. Evaluation of the procedures of total gastrectomy and proximal gastrectomy. Japan Surgical Society. 1965;66:1285–1287

29. Iwahashi M, Nakamori M, Nakamura M. Evaluation of double tract reconstruction after total gastrectomy in patients with gastric cancer: Prospective randomized controlled trial. World Journal of Surgery. 20093; 3:1882– 1888. https://doi.org/10.1007/s00268–009–0109–0

30. Bandurski R, Gryko M, Kamocki Z. Double tract reconstruction (DTR) – An alternative type of digestive tract reconstructive procedure after total gastrectomy – own experience. Polski Przeglad Chirurgiczny. 2011;83:70–75. https://doi.org/10.2478/v10035–011–0011-y

31. Maksimovic S. Double tract reconstruction after total gastrectomy in patients with gastric cancer: our experience. Med Arh. 2010;64(2):116–118.

32. Li, S., Gu, L., Shen, Z. et al. A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer. BMC Surg 19, 117 (2019). https://doi.org/10.1186/s12893–019–0584–7

33. Seo S. Stomach resection transplanting jejunum. Japan Surgical Society. 1941;42:1004

34. Longmire WP, Beal JM. Construction of a substitute gastric reservoir following total gastrectomy. Annals of Surgery. 1952;135:637–645. https://doi.org/10.1097/00000658–195205000–00007

35. Lee CMJ. Transposition of a colon segment as a gastric reservoir after total gastrectomy. Surgery, Gynecology & Obstetrics. 19519;2:456–465

36. Hunnicutt AJ. Replacing stomach after total gastrectomy with right ileocolon. A.M.A. Archives of Surgery. 1952;65:1–11. https://doi.org/10.1001/archsurg.1952.01260020013001

37. Андросов П. И. Замещение желудка участком толстой кишки при тотальной гастрэктомии. Хирургия, 1959, 11, 144–145.

38. Hays RP. Anatomic and physiologic reconstruction following total gastrectomy by the use of a jejunal food pouch. Surgical Forum. 1953;4:291–296.

39. Gütgemann A, Schreiber HW, Bernhard A. Erfahrungen mit der totalen Gastrektomie. Langenbecks Arch Klin Chir Ver Dtsch Z Chir. 1963;303:73–93. https://doi.org/10.1007/bf01440407

40. Poth EJ, Smith LB. Gastric pouches: Their evaluation. American Journal of Surgery. 1966; 112:721–727. https://doi.org/10.1016/0002–9610(66)90112–7

41. Kieninger G, Koslowski L, Kummer D. Stomach replacement by iso-anisoperistaltic jejunum interposition (Tübinger replacement stomach). Chirurg. 1981;52:505– 510

42. Herbington JL. Remedial operations for severe postgastrectomy symptoms (dumping): Emphasis on an antiperistaltic (reversed) jejunal segment interpolated between gastric remnant and duodenum and role of vagotomy. Annals of Surgery. 1965;162:789–862. https://doi.org/10.1097/00000658–196511000–00001

43. Cuschieri A. Long term evaluation of a reservoir jejunal interposition with an isoperistaltic conduit in the management of patients with the small stomach syndrome. Th e British Journal of Surgery. 19826;9:386–388. https://doi.org/10.1002/bjs.1800690710

44. Schwarz A, Büchler M, Usinger K. Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the Ulm pouch: Prospective randomized clinical study. World Journal of Surgery. 1996;20:60–66; discussion 66–67. https://doi.org/10.1007/s002689900011

45. Longmire WP, Beal JM. Construction of a substitute gastric reservoir following total gastrectomy. Annals of Surgery. 1952;135:637–645. https://doi.org/10.1097/00000658–195205000–00007

46. Baumgartl F, Kremer K, Schreiber HW. Spezielle Chirurgie für die Praxis. Stuttgart: Georg Th ieme Verlag; 1973. 738 p. https://doi.org/10.1002/bjs.1800610431

47. Е.И. Захаров, А. Е. Захаров. Тонкокишечная пластика при гастрэктомии и резекции желудка Государственное издательство медицинской литературы, Москва, 1962, 166 с.

48. Zherlov G, Koshel A, Orlova Y. New type of jejunal interposition method aft er gastrectomy. World Journal of Surgery. 2006;30:1475–1480. https://doi.org/10.1007/s00268–005–7980–0

49. А. Л. Лужанский, О. И. Дударь. Принципы формирования аналога желудка из петли тонкой кишки после гастрэктомии Российский журнал биомеханики, 2006, том 10, № 1: 79–87.

50. Е.И. Брехов, С. П. Мизин, И. Г. Репин, А. А. Шипова. Обоснование способа восстановления непрерывности желудочно-кишечного тракта после резекции желудка Хирургия. Журнал им. Н. И. Пирогова. 2013;(6): 8–13.

51. Д. В. Ручкин, Ц. Ян. Еюногастропластика как альтернативный способ реконструкции пищеварительного тракта после гастрэктомии Хирургия. Журнал им. Н. И. Пирогова. 2015;(9):57–62.

52. Yang YS, Chen LQ, Yan XX, Liu YL. Preservation versus non-preservation of the duodenal passage following total gastrectomy: a systematic review. J Gastrointest Surg. 2013;17(5):877‐886. https://doi.org/10.1007/s11605–013–2174–9

53. Fan KX, Xu ZF, Wang MR, Li DT, Yang XS, Guo J. Outcomes for jejunal interposition reconstruction compared with Roux-en-Y anastomosis: A meta-analysis. World J Gastroenterol. 2015;21(10):3093–3099. https://doi.org/10.3748/wjg.v21.i10.3093

54. Ding X, Yan F, Liang H, et al. Functional jejunal interposition, a reconstruction procedure, promotes functional outcomes after total gastrectomy. BMC Surg. 2015;15:43. Published 2015 Apr 15. https://doi.org/10.1186/s12893–015–0032–2

55. Dikic S, Randjelovic T, Dragojevic S, et al. Early dumping syndrome and reflux esophagitis prevention with pouch reconstruction. J Surg Res. 2012;175(1):56‐61. https://doi.org/10.1016/j.jss.2011.02.001

56. Zonča P, Malý T, Ihnát P, Peteja M, Kraft O, Kuca K. J-pouch versus Roux-en-Y reconstruction after gastrectomy: functional assessment and quality of life (randomized trial). Onco Targets Th er. 2016;10:13–19. Published 2016 Dec 16. https://doi.org/10.2147/ott.s99628

57. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer (2020). https://doi.org/10.1007/s10120–020–01042-y

58. Chen S, Chen XJ, Chen DW, Xiang J, Peng JS. A novel anti-refl ux reconstruction aft er laparoscopic total gastrectomy: jejunal pouch-esophageal anti-refl ux anastomosis. Gastroenterol Rep (Oxf). 2018;6(3):234–238. https://doi.org/10.1093/gastro/goy019

59. Ward MA, Ujiki MB. Creation of a jejunal pouch during laparoscopic total gastrectomy and Roux-en-Y esophagojejunostomy. Ann Surg Oncol. 2017;24:184–6. https://doi.org/10.1245/s10434–016–5540–5

60. Р. А. Зубков, А. В. Шелехов, Е. С. Барышников, А. С. Загайнов. Лапароскопическая гастрэктомия с еюногастропластикой. Сибирский онкологический журнал. 2016. Т. 15, № 4. С. 70–74 DOI: 10.21294/1814–4861–2016–15–4–70–74.