全胃切除术后的两种消化道重建方式

Comparative Study on Two Procedures of Digestive Reconstruction after Total Gastrectomy

目的:探讨全胃切除术后较为合理的消化道重建术式。方法:对2001年6月—2008年6月所施行的全胃切除术采用保留幽门空肠间置术和食管空肠Orr式Roux-en-y吻合术两种消化道重建术式,对其术后12个月无肿瘤复发的96例患者进行营养状况(体重、消化道症状及营养指标)观察对比。结果:术后12个月随访,两组间营养状况无明显差异(P>0.05﹚,保留幽门空肠间置重建组较空肠食管Roux-en-y吻合术组倾倒综合症和返流性食管炎发生率更低。结论:保留幽门空肠间置重建术可作为早、中期上半部胃癌全胃切除术后重建时的优先术式,食管空肠Roux-en-y吻合术可作为全胃切除术后不能行保留幽门空肠间置重建术的有效补充。

Objective To investigate the rational digestive reconstruction after total gastrectomy for gastric malignancy. Methods Two procedures of digestive reconstruction were performed after total gastrectomy in 96 cases with gastric carcinoma. The two procedures were pylorus ring preserving jejunal interposition and Orr Roux-en-Y type digestive tract reconstruction. The body weight, digestive tract symptoms, nutritional status in 1 year after operation were compared Results While in postoperative one year follow-up, no difference was found between the nutritional status of the two groups for patients without recurrence （P〈0.05）. The pylorus ring preserving jejunal interposition had an advantage of anti-esophageal reflux and less occurrence of dumping syndrome （P〈0.05）. Conclusion The pylorus ring preserving jejunal interposition is rational digestive reconstruction after total gatrectomy for early and mid-upper gastric malignancy and the Orr Roux-en-Y type digestive tract reconstruction is an effective supplement in case the pylorus ring preserving jejunal interposition is impossible to be performed.