全胃切除治疗胃恶性肿瘤(例44附报告)

Total Gastrectomy for Gastric Malignancy

本文报告华西医大普外科1981～1989.2月间作了全胃切除的胃恶性肿瘤44例,手术死亡率2.27％,近期并发症31.8％,主要为胸部并发症,吻合口漏只1例。对远期生存者作了消化吸收功能研究,多数病人代胃空物功能良好。本文讨论了①全胃切除的指征;②如何降低手术死亡率及远期并发症;③推荐Roux-n-y,P型空肠袢代胃术或P型空肠袢间置代胃术,两者均为合理的消化道重建方式。

Forty-four cases of gastric malignant tumors were treated with total gastrectomy from 1981 through February, 1989 in the Department of General Surgery. The operative mortality rate was 2.27%. Early compliations comprised 31.8%, mainly the thoracic complication. The leakage from stomal anastomosis only occurred in one case. The functions of digestion and absorption after total gastrectomy were invest gated. In most cases the jejunal segment as a substituted stomach was satisfactory. The following pro-blems were disccused: (1) the indications of total gastrectomy(2) how to decrease the operative mortality and complications(3) the rational procedures for reconstruction of the alimentary tract after total gastrectomy. The procedure as Roux-en-y, P-figure jejunal pouch or P-figure jejunal pouch interposition was preferred.