连续间置空肠折叠代胃术在全胃切除术中的应用研究

Clinical Study on Continuous-Separate-Folded-Jejunum-Replacing-Stomach Method in Digestive Tract Reconstruction after Total Gastrectomy

目的探讨连续间置空肠折叠代胃术在全胃切除术中的应用.方法选择42例采用连续间置空肠折叠代胃术式,与22例Roux-en-Y术式在近远期营养状况、术后并发症及Visick指数方面进行对比分析.结果近期(6个月)疗效方面,连续间置空肠折叠代胃术组在进食次数、每日进食量、体重增加方面优于Roux-en-Y术式组(P<0.05).该术式代胃的容量明显增大,排空时间延长,与Roux-en-Y术式组比较差异显著(P<0.01).在远期(1年)疗效方面,连续间置空肠折叠代胃术组与Roux-en-Y术组在进食次数、每日进食量、体重增加方面差异仍十分显著(P<0.05,P<0.01),连续间置空肠折叠代胃术组消化道症状发生率低,其中返流性食管炎、恶性呕吐、食欲下降、滞留综合征(RSS)的发生率与Roux-en-Y术组相比差异显著(P<0.05).连续间置空肠折叠代胃术其Visick指数为Ⅰ～Ⅱ级者占95.2%,而Roux-en-Y术组,50%的病人Visick指数为Ⅲ～Ⅳ级,术后体重明显下降(P<0.05).结论连续间置空肠折叠代胃术后能够在较短的时间内恢复和超过术前的身体状况.有效地防止胆汁、胰液、食物返流,避免了返流性食管炎的发生,该术式是全胃切除后理想的消化道重建术式.

Objective To study ideal replacing-stomach method after total gastrectomy.Methods fourty-two cases were operated with continuous-separate-folded-jejunum-replacing-stomach（CSFJRS） method.22 cases were operated with Roux-en-Y method.Short-term nutritional status,long-term status,postoperative complications and Visick Index of the three groups were compaired.Results As the short-term（6 months） curative effect,eating numbers,appetite perday,body weight gaining of the group operated with CSFJRS method was significantly ameliorated than the other group（P〈0.05）.The volume of the replaced stomach of the group operated with CSFJRS method were bigger than those of the other two groups.The empty time of the replaced stomach of the group operated with CSFJRS method was shorter than that of the othe group（P〈0.01）.As the longterm（1 year） curative effect,eating numbers,appetite per day,body weight gaining of the group operated with CSFJRS method were significantly different from the group operated with Roux-en-Y method（P〈0.01）.The incidences of digestive tract symptoms including reflux esophagitis,malignant vomiting,appetite descending,Retention Stagnation Syndrom（RSS） of the former group was lower than the group operated with Roux-en-Y method（P〈0.05）.95.2% of the Visick Indexes of the former group were grade and,but 50% of the Visick Indexes of the Roux-en-Y method group were grade and,there were significantly difference between the two groups（P〈0.05）.Conclusion The body status could be recovered in short time and be better than that before operation with the CSFJRS method.The method could prevent reflux of bile,pancreatic juice and food,prevent the incidence of reflus esophagitis.The method was an ideal replacing-stomach method after total gastrectomy.