近端胃切除术中附加与不附加幽门成形的应用评价

Evaluation of proximal gastrectomy with or without additional pyloroplasty

目的评价近端胃切除术中附加幽门成形与否在预防病人术后反流性食管炎以及残胃排空障碍中的临床价值。方法86例病人随机分为附加幽门成形组45例和不附加幽门成形组41例。结果附加幽门成形组病人术后:置放胃管时间比不附加幽门成形组短(P<0.05),胃液引流量比不附加幽门成形组明显减少(P<0.01),上腹疼痛不适、反酸、胸骨后烧灼感以及餐后饱胀、嗳气等症状比不附加幽门成形组明显轻而且少(P<0.001),3月后残胃钡餐/或胃镜提示反流性食管炎发生率明显比不附加幽门成形组低(P<0.001)。结论附加幽门成形利于病人术后残胃排空,显著减少残胃内容物的潴留,能有效预防或降低病人术后反流性食管炎以及残胃排空障碍的发生,其临床实用价值较高。

Objective We evaluated proximal gastrectomy with or without additional pyloroplasty in the prevention of postoperative patients reflux esophagitis and gastric remnant emptying disorder. Methods 86 patients of proximal gastrectomy were randomly divided into two groups, including study group and control group. 45 cases of study group were treated with pyloroplasty and 41 cases of control group were treated without pyloroplasty. Results Compared with controls, gastric canal retention time in study group shortened （P〈0. 05）, and gastric juice drainage in study group significantly reduced （P 〈 0.05）. The symptoms, including stomachache, sour regurgitation, pyrosis, abdominal distention and belch, in study group were not severe as that in control group （P〈0. 05）. The incidence rate of postoperative reflux esophagitis and gastric remnant emptying disorder in study group was significantly decreased compared with that in control group （P〈0. 05）. Conclusion Proximal gastrectomy with additional pyloroplasty can promote gastric remnant emptying, reduce the remnant stomach content retention, decease the incidence of postoperative reflux esophagitis.