郝氏法全胃切除术后消化道重建术临床分析

Clinical analysis of alimentary tract reconstruction after Haoshi total gastrectomy

目的探讨胃癌全胃切除术后理想的消化道重建术式。方法对20例胃癌患者行全胃切除术后,分别行袢式空肠代胃改良Ⅰ式、Ⅱ式、Ⅲ式及郝氏法顺行性间置空肠代胃术4种消化道重建术。术后观察患者进食量、体重、血浆营养参数、全血细胞计数、代胃的储存及排空功能、预后营养指数(PNI)、Visick指数的比较等指标结果。结果与袢式空肠代胃改良Ⅰ式、Ⅱ式、Ⅲ式相比,郝氏法顺行性间置空肠代胃术术后体重恢复好,血浆营养参数和PNI均较高,且术后无明显消化道症状。结论胃癌全胃切除术术后消化道重建应构建代胃并保持摄入食物通过十二指肠。郝氏法顺行性间置空肠代胃术术式是一种较理想的术式。

Objective To investigate the optimum reconstruction of alimentary tract after total gastrectomy for malignant disease, especially the necessity of gastric substitute and duodenal passage. Methods Four kinds of reconstruction methods of alimentary tract were used in 20 patients who underwent total gastrectomy： Braun Ⅰ,Ⅱ,Ⅲ,and Haoshi antigrade jejunal interposition. Postoperative complaints, body weight, food intake, serum nutritional parameters, complete blood count, half emptying time of the gastric substitute, PNI, Visick index were observed. Results As compared with Braun Ⅰand Ⅱ and Ⅲ, Haoshi antigrade jejunal interposition method showed better body weight,higher nutritional parameters and better PNI,Coneluslon It is essential to construct a gastric substitute and maintain the alimentary tract flowing through the duodenum after total gastrectomy for cancer, and Haoshi antigrade jejunal interposition might be a better choice for the patients who underwent gastrectomy.