间置空肠“双通道”在近端胃切除消化道重建术中的应用

Application of double tract digestive reconstruction of jejunal interposition after proximal gastrectomy

目的设计一种能有效防止反流性食管炎的近胃端切除术后消化道的重建方式。方法福建省晋江市医院2007年3月至2008年7月间对36例近端胃恶性肿瘤的病人采用间置空肠"双通道"消化道重建并进行临床观察。结果全组病例无围手术期死亡,无吻合口漏、倾倒综合征发生。手术时间和出血量无明显增加。约90%以上病人术后半年每日进食3～4次,每餐进食200～400g,通过胃镜检查未出现严重反流性食管炎的病例,89%病人甚至无食管炎的症状,体重基本恢复至术前水平。结论间置空肠"双通道"较好地解决了反流性食管炎的发生,明显改善了病人的生活质量,并且术后化疗的依从性也得到了保证,是一种近端胃大部切除后消化道重建的颇为理想的术式。

Objective To design the ideal digestive reconstruction after proximal gastrectomy to prevent reflux esophagitis. Methods Thirty-six patients who underwent double tract digestive reconstruction of jejunal interposition during March 2007 and July 2008 at Jinjiang City Hospital of Fujian Province were analyzed retrospectively. Results No patient died and there was no annastomotic ledkage, dumping syndrome occurred during perioperative period. There was no differences of operating duration and the bleeding volume. Half year later, about ninety percent of patients could take about 200-400 g food at each meal （3 or 4 times a day）. No severe reflux esophagitis was found by the gastroscopic examination, Eighty-nine percent of patients had not any syndrome of reflux esophagitis and their body weight approached to the preoperative level. Conclusion Double tract digestive reconstruction of jejunal interposition has several advantages including less reflux esophagitis, the higher quality of life, the higher acceptance of chemotherapy. It is a ideal digestive reconstruction after proximal gastrectomy.