“贲门”的重塑：近端胃切除术后抗反流术式的演变与双肌瓣吻合(Kamikawa)的 临床应用前景

Reshaping the Cardia: Evolution of Anti-Reflux Procedures after Proximal Gastrectomy and the Clinical Prospects of the Double-Flap Technique (Kamikawa Method)

摘要: 近端胃切除术在胃上部及食管胃结合部早期癌的治疗中日益受到重视，但术后反流性食管炎一度限制其应用。如何重建有效的抗反流机制是该领域的核心挑战。本文系统回顾了近端胃切除术后主要抗反流重建术式的演变，重点剖析双通道重建、管状胃吻合及双肌瓣吻合(Kamikawa法)的生物力学原理与技术演进。现有证据表明，双肌瓣吻合通过模拟生理性贲门瓣膜机制，可提供可靠的抗反流效果并维持良好营养状态，但技术难度较高；双通道重建则以技术相对简单、抗反流效果确切作为重要备选。本文进一步提出了基于残胃大小、食管裂孔状态、肿瘤位置及患者体型的初步临床决策框架，并深入探讨了不同重建方式对残胃排空、胃酸分泌及Ghrelin调节等功能学机制的差异。本文认为，机器人辅助等新平台的融合将推动抗反流技术的标准化与普及化，未来需通过高质量研究明确各术式的长期疗效与最佳适应人群，以实现个体化精准治疗。

Abstract: Proximal gastrectomy has gained increasing attention in the treatment of early-stage cancers of the upper stomach and gastroesophageal junction. However, postoperative reflux esophagitis once limited its application. Reconstructing an effective anti-reflux mechanism remains the core challenge in this field. This article systematically reviews the evolution of major anti-reflux reconstruction techniques following proximal gastrectomy, with a focus on analyzing the biomechanical principles and technical advancements of double-tract reconstruction, tubular stomach anastomosis, and double-muscle flap anastomosis (Kamikawa method). Current evidence indicates that double-muscle flap anastomosis, by mimicking the physiological cardia valve mechanism, provides reliable anti-reflux effects while maintaining good nutritional status, though it presents higher technical difficulty; conversely, double-tract reconstruction offers a simpler technique and definitive anti-reflux outcomes, serving as a key alternative. This article further proposes a preliminary clinical decision-making framework based on remnant stomach size, hiatal status, tumor location, and patient body habitus, and delves into the functional mechanistic differences among reconstruction techniques regarding remnant gastric emptying, acid secretion, and ghrelin regulation. The authors propose that the integration of new platforms such as robotic assistance will standardize and popularize anti-reflux techniques. Future high-quality research is needed to clarify the long-term efficacy and optimal patient populations for each technique, enabling personalized precision treatment.