胃十二指肠端侧吻合式胃大部切除术治疗十二指肠球部巨大溃疡

Subtotal gastrectomy and gastroduodenal end-to-side anastomosis for treating duodenal bulb macroulcer

目的 :为了克服传统BillrothⅡ胃大部切除术远期并发症发生率高的弊端 ,寻找十二指肠球部巨大溃疡手术治疗的理想术式。方法 :对 49例十二指肠球部巨大溃疡切除困难者 ,胃大部切除后 ,将胃小弯封闭 ,胃大弯与十二指肠 1、2部交界处端侧吻合。结果 :全组病人除 1例术后第 7天胃小弯侧粘膜下血管结扎线脱落并出血外 ,余均恢复顺利 ;术后胃液胆红素测定均为阴性 ,pH值平均由术前的 2 7±0 5上升到 5 2± 0 4,12例钡餐检查见吻合口有节制食物排空功能。结论 :该术式符合生理通道 ,有较满意的节制排空及抗返流功能 ,无输入袢症候群及吻合口后间隙 ,操作简单 。

To find an ideal surgical therapy for duodenal bulb macroulcer which can replace the conventional Billroth Ⅱ procedure and reduce the rate of long term complication.Methods:Forty nine patients with duodental bulb macroulcer were operated by subtotal gastrectomy and gastroduodenal end to side anastomosis.Results:One patient bleeded on the seventh operative day,because of the blood vessel's ligature sheded at the submucous of the lesser curvature of stomach,the others recoveried satisfactoryly.Bilirubin assay in the gastric juice,was negative and pH scale rose from 2.7±0 5 to 5.2±0 4. Barium meal examination showed that the'Reproduced Pyloruses'had satisfactory function of evacuation control.Conclusion: This procedure accords with normal physiolagical channel.It has satisfactory function of evacuation control and anti reflux.There is no afferent influent loop syndrome or posterior anastomotic stoma space.It is easily operated,safy and reliably.