食管空肠贮袋双道吻合术式用于消化道重建的临床研究

A Clinical Study of Esophagojejunostomy with a Storable Jejunum Bag and Double Tracts for the Reconstruction of the Alimentary Tract

目的 探讨一种新的全胃切除术后消化道重建的理想术式。方法 在全胃切除后 ,制作一个“S”或“W”形空肠贮袋 ,与食管做双道吻合。结果 2 1例病人无并发症发生 ,经钡餐透视检查均有钡剂通过十二指肠 ,钡剂进入量为 2 0 %～ 80 % ,且存钡时间最长者超过 12 0min ,术后分别于 1月后、3月后复查 ,Hb ,Tp ,体重、进食量均达到或超过术前水平。结论 该术式使重建消化道的食物储存容量增加 ,排空时间延长 ,且降低了并发症的发生率 ;更多的食物通过十二指肠的正常生理途径 ,使进食与消化液分泌得以同步进行 ,同时 ,手术操作较代胃手术简便、安全 。

Objective To explore a new ideal operation style for the reconstruction of the alimentary tract after total gastrectomy.Methods A storable jejunum bag with a shape of “S” or “W” was made after total gastrectomy.The ends of the esophagus,duodenum and jejunum were anastomosed with the side of the jejunum at different levels.Double tracts,duodenum-jejunum tract and jejunum tract,were formed under the storable jejunum bag.Results No complications occurred to any patients.About 20%～80% barium contrast passed through the duodenum-jejunum tract in all the 21 patients during the X-ray fluoroscopy.The barium contrast could be sustained in the reconstructed alimentary tract for over 120 minutes.During the follow-up at the end of the first month and the third month after operation,it was found that the levels of hemoglobin ,total protein,body weight and the amount of each meal of the patients were as high as or higher than those before operation.ConclusionThis style of operation could increase the amount of food stored in the reconstructed alimentary tract,postpone discharging of food,decrease the incidence of stomal leakage,stomal stenosis,dumping syndrome and reflux esophagitis.Since more food could enter the duodenum which is the normal physiological pathway,taking in food would lead to the secretion of digestive juice.This kind of operation is simpler and safer than the operation of stomach substitution,therefore,it is a alternative modality for the reconstruction of alimentary tract after total gastrectomy.