Ｕ領域早期胃癌に対する噴門側胃切除術，空腸嚢間置再建法の臨床的検討

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  • Critical Evaluation of Jejunal Pouch Interposition after Proximal Gastrectomy for Early Gastric Cancer.

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Introduction: We studied the critical evaluation of jejunal pouch interposition (JPI). Materials and Methods: Since 1996, we have used a procedure in which a 15 cm double jejunal pouch is interposed between the esophagus and remnant stomach after proximal gastrectomy, JPI for patients with early gastric cancer in the upper third of the stocach. The distal resection line was 10 cm from the pyloric ring in the lesser curvature and 12 cm away in the greater curvature. We conducted D2 excluding the lymph nodes along right gastroepiploic vessels (in part) and at the splenic hilum. We assessed the results of JPI in 49 patients, compared to 41 undergoing total gastrectomy with Roux en Y reconstruction (RY) during the same period. Results: Subjects were 34 men with a mean age of 61 years. Histopathological examination showed 18 with intramucosal, 21 with submucosal lesions, and 10 deeper than the proper muscular layer. No recurrent cases were observed and all patients continue to survive. Clinical variables including operation time, bleeding volume, and the postoperative hospitalization days, and postoperative complications including anastomotic leakage, stenosis, pancreatitis, hemorrhage, and intestinal obstruction. No significant differences were seen between groups. Postoperative endoscopic examination showed no significant defferences in stenosis and reflux esophagitis between groups. Reflux esophagitis followed by increased food residue and remnant gastritis was observed in JPI. Postoperative weight changes were lower in JPI than in RY at 6 months (p=0. 0132) and at 1 year (p=0.0462) after surgery. Vitamin B12 in JPI tended to be high 2 years after surgery. Postoperative symptoms (questionnaire) showed appetite, nausea or vomiting, diarrhea, and early dumping syndrome to be significantly better (p=0.0132, 0.0014, <0.0001, 0.0051) and oral intake compared to that preoperatively was significantly higher in JPI 2 years after operation. However, heartburn in JPI was significantly higher (p=0. 0001). Conclusion: JPI involves low weight loss and good oral intake in the early phase after surgery. It is necessary to follow up long-term to evaluate heartburn and Vitamin B12 and further improve postoperative quality of life.

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