全胃切除横结肠代胃术45例报告

Transposition of a transverse colon segment as a gastric reservoir following total gastrectomy

目的 探讨理想的全胃切除术后的重建方式。方法 对 1987～ 1999年经病理证实行全胃切除术胃恶性肿瘤 45例进行回顾性分析。保留幽门结肠代胃术 2 1例 ,间置结肠代胃 2 4例 ,观察术后并发症、Visick指数、血浆营养参数、全血细胞计数、代胃的储存及排空功能、体重变化。结果 术后体重恢复好 ,血浆营养参数高。 88.9%的术后病人的Visick指数为Ⅰ～Ⅱ ,保留幽门的结肠代胃术有更高存留时间 ,更少的食管返流。结论 胃恶性肿瘤全胃切除术后消化道重建结肠代胃保证摄入食物通过十二指肠。结肠代胃是较理想的术式 ,保留幽门的结肠代胃更佳。

Objective To explore the ideal procedure of digestive tract reconstruction after total gastrectomy.Methods Fory-five patients with gastric malignant tumor confirmed pathologically underwent different types of reconstruction procedures for total gastrectomy and were analyzed retrospectively.The pylorus preserving gastrectomy was used in 21 cases colonic interposition in 24 cases respectively.The postprandial symptoms and post-operative complications,Visick scoring,completes blood count,serum nutritional parameters,half-emptying time of the gastric substitute,body weight,food intake were evaluated.Results The body weight of the patients after operation was increased and nutritional parameters were high.The Visick scoring of the 88.9% patients was Ⅰ-Ⅱ grades.As compared with colonic interposition,the pylorus preserving gastrectomy showed less reflux esophagitis and long half-emptying time.Conclusion It is essential to construct a gastric substitute and maintain the alimentary tract flowing through the duodenum after total gastrectomy for malignant tumor,and pylorus preserving gastrectomy may be a better choice in the operation of gastrectomy.