全胃切除术后两种常用消化道重建方式的比较

Comparison on two kinds of procedures commonly applied in digestive tract reconstruction after total gastrectomy.

目的探讨全胃切除术合理的消化道重建方式。方法回顾分析我院1999～2008年所开展全胃切除手术病例,选择其中最常采用的P袢空肠Roux-en-Y重建术和功能性空肠间置吻合术,对其手术难度、术后病人的并发症及营养差异进行比较。结果两种手术方法手术难度、术后并发症相差不太。P袢空肠Roux-en-Y重建术后早期适应性较好;功能性空肠间置吻合术后病人后期营养优于前者。结论全胃切除后,P袢Roux-en-Y吻合术和功能性空肠间置吻合术在改善患者术后症状和生活质量等方面是比较理想的重建术式,但功能性空肠间置吻合术是一种更符合生理,更能解决全胃切除后病人发生营养障碍的术式。

Objective To explore the reasonable procedures for digestive tract reconstruction after total gastrectomy. Methods The clinical data of patients with total gastrectomy during 1999 to 2008 were retrospectively reviewed and analyzed, and their postoperative complications, operative difficulties and nutritional differences of P limb Roux - en - Y reconstraction and Functional Roux were compared. Results There was no difference in operative difficulties and postoperative complications between these two kinds of operations. P - limb Roux - en - Y reconstruction was better in early postoperative adaptation. Late stage nutrition of patients after functional jejunal interposition pouch was better than the former. Conclusion P limb Roux - e - Y and functional jejunal interposition pouch are ideal reconstructive ways for reducing postoperative symptoms and impwving life quality of patients after total gastrectomy, but functional jejunal interposition pouch is a more ideal physiological procedure and it can be a better way for solving the nutritional disfunction after gastrectomy.