全胃切除食管空肠Y型吻合空肠三腔代胃术29例分析

Total gastrectomy with Roux-Y type esophagojejunostsmy and reconstruction of Stomach with Jejunum (three barrels), a report of 29 cases.

自1981年2月至1991年3月,作者对29例(男15例,女14例)胃恶性肿瘤病人施行全胃切除食管空肠Roux-Y吻合空肠三腔代胃术。病人年龄26～68岁(平均48.2岁)。肿瘤位于胃体和/或体窦部14例,胃底和/或底体部9例,胃底贲门部4例,全胃2例。病理诊断;胃未分化腺癌3例,低分化腺癌16例,高分化腺癌7例,恶性淋巴瘤2例,平滑肌肉瘤1例。治疗结果表明多数病人恢复迅速,但发生膈下脓肿4例,胸部感染5例,腹部切口裂开1例。随访结果29例中22例已死亡,术后存活6～8个月7例,12～14个月14例,29个月1例。7例仍存活,其中3例为术后10～16个月,2例为25个月,1例为7年和1例存活11年。我们认为全胃切除食管空肠Roux-Y吻合空肠三腔代胃术具有以下优点:①宽大的代胃袋能贮存和吸收食物,②食物与胆胰液可在代胃袋内混合,有助消化和吸收,③手术不太复杂,④术后无返流性食管炎、倾倒综合征、腹泻等后遗症。

From 1981 to 1991, total gastrectomy with RouxY type eaophagojejunostomy and reconstruction of stomach with jejunum (three barrels) were performed in 29 eases (15 male. 14 female) with malignant gastric tumors. The age of the patients ranged from 26 to 68 years (mean value 48.2). The positions of tumour were in antrum or antrum and body of stomach in 14 cases, in fundus of stomach or fundus and body of stomach om 9 cases, fundus and cardiac part in 4 cases, total stomach in 2 cases. The pathological classifications include gastric adenocarcinoma (26 eases), gastric lymphoma (2 cases), and gastric leimyosarcoma (1 case). The result of treatment showed all patients recoveried soon, but suphrenic abscess oecured in 4 cases, thoracic cavity in fection in 5 cases, abdominal wound dehiscence in 1 case. Following-up showed that 22 of 29 patients have dead, living time was 6-8 months after operation in 7 cases. 12-14 months in 14 cases, 29 months in 1 case. 7patients are still living, 3 cases are in 10-16 months after operation, 2 cases are in 25 months, 1 case in 7 years, and 1 in 11 years. It may be concluded that Total gastrectomy with Roux-Y type esophagojejunostomy and reconstruction of stomach with jejunum (three barrels) has following advantager: (1) lager reconstructed stomach can store and absorb food, (2) food can be mixed with biliary and pancreatic juice in reconstructed stomach and can be digestioned absorbed, (3) surgical procedure is not very difficult, (4) postoperative complications, such as reflux esophagitis, dumping syndrome, and diarrhea, are not common.