全胃切除调节型双通道间置空肠消化道重建

New Double Tract Digestive Reconstruction of Total Gastrectomy:The Modified Functional Jejunal Interposition

目的介绍一种新的全胃切除消化道重建术。方法选取我院2004年6月至2006年3月期间行全胃切除病例38例。在行消化道重建时,对功能性空肠间置代胃(FJI)术作如下改良:将输出袢适度丝线结扎改为部分缩窄缝合2～3针,适当缩短输入袢肠管至20～25cm,Braun吻合口距Treitz韧带10cm,以食管空肠及Braun吻合口无张力为度。结果全组病例无围手术期死亡、吻合口漏及倾倒综合征发生。Roux-en-Y滞留综合征2例;返流性食管炎1例;Visick分级:35例Ⅰ级,3例Ⅱ级。血清营养学指标:仅2例血红蛋白低于正常。术后6个月,36例进食量和体重恢复术前水平,仅2例体重下降。造影钡剂主要进入十二指肠通道,少量通过部分缩窄通道。结论对FJI重建术的改良,不仅保留了原法的全部优点,而且可进一步降低并发症,改善患者生活质量,但需进行进一步的前瞻性对比研究。

Objective To describe a new technique for digestive tract reconstruction of total gastrectomy. Methods The modified functional jejunal interposition （FJI） was performed in 38 patients who underwent total gastrectomy between June 2004 and March 2006. At digestive tract reconstruction, the jejunum with suitable suture ligated at 2 cm distal to side-to-end jejunoduodenostomy was changed to sew up 2--3 needles and to narrow it. End- to-side esophagojejunostomy to Treitz ligament was shortened to 20--25 cm befittingly. Side-to-side jejunojejunosto- my to Treitz ligament was 10 cm. Both esophagojejunostomy and jejunojejunostomy must not be tensioned. Results No patients died or had anastomotic leakage in perioperative period. Roux-en-Y stasis syndrome （RSS） was in 2 patients. The Visick grade： 35 patients were grade Ⅰ, 3 patients were grade Ⅱ, Serum nutritional parameters in 2 patients hemoglobin was only lower than normal. At 6 months after operation, food intake per meal and body weight were recovered to the preoperative level in 36 patients, and only 2 patients appeared weight worse. One patient had reflux esophagitis and no dumping syndrome occurred. Through the upper gastrointestinal radiograph, the bariums entered into duodenal channels mostly, and a little into the narrow channels. Conclusion The modified FJI not only reserved all advantages of the primary procedure, but also could further lower the complications and improve of the quantity life of the patients who were underwent total gastrectomy. It would be necessary for further prospective randomized controlled trial in the largescale cases.