全胃切除术后消化道重建方式的临床研究

A clinical study of digestive tract reconstruction after total gastre ctomy

目的探讨全胃切除术后更符合生理的消化道重建方式.方法对1985年1月～2002年12月间经病理证实行全胃切除术胃癌病例682例进行回顾性分析.682例中,功能性间置空肠代胃术(FJI)163例;袢式吻合47例,改良袢式吻合Ⅰ型和Ⅱ型340例,‘P'型Roux-en-y空肠代胃术87例、‘P'型空肠间置代胃术45例.比较其术后并发症、体重变化.结果功能性间置空肠代胃术在Roux-en-y综合征发生率、预后营养指数、进食量、体重减轻各个方面分别优于或等于袢式吻合、改良袢式吻合Ⅰ型和Ⅱ型、‘P'型Rouxen-y空肠代胃术和‘P'型空肠间置代胃术.结论功能性间置空肠代胃术保持了重建消化道神经-肌肉功能的连续性,恢复食物经过十二指肠通道,对于减少全胃术后并发症、提高生存质量有重要的临床意义,是全胃切除术后一种合理的消化道重建方式.

Objective To explore the optimum digestiv e tract reconstruction after total gastrectomy. Methods Al l 682 patients with histologically proved gastric cancer were underwent six type s of reconstructive procedures for total gastrectomy and were analyzed retrospec tively. Results The parameters were evaluated in the fu nctional jejunal interposition are better than or equal to those of Braun ,modi fied Braun type ⅠandⅡ,‘P’-Roux-en-y and “P” interposition Roux-en-y metho ds. Conclusion The functional jejunal interposition whic h maintains the continuity of neuo-musule functional of the reconstructive gastr ic tract and the canal of the chyme through the duodenal is an reasonable recons truction after total gastrectomy .