胃切除术后应用改良Braun术式重建胃肠道预防返流性胃炎

Modified braun's operation for preventing reflux gastritis post gastrectomy

目的探讨预防胃十二指肠溃疡术后碱性返流性胃炎的发生和逆转原残胃粘膜的炎性病变的新手术治疗方法。方法采用胃部分切除术后改良Ｂｒａｕｎ术式对胃十二指肠球部溃疡病急性穿孔并弥漫性腹膜炎２３例病人进行治疗。术后１～２年随访２２例，其中１９例行胃镜复查及残胃液甘胆酸（ＣＧ）测定、幽门螺杆菌（ＨＰ）检查。９例钡餐透视观察残胃排空情况。结果所有病人术后恢复好，Ｖｉｓｉｃｋ分级优良率为９５７％；残胃炎消除率为７３７％；ＨＰ感染率由术前的５８％降至２１％；胃镜及钡餐检查无１例出现胆汁返流，仅１例残胃排空延迟钡餐检查为输出袢粘连。结论改良Ｂｒａｕｎ术式的应用可有效地减少残胃炎发生。

Objective To explore a new operation for preventing the occurrence of alklinic gastritis after gastrectomy for peptic ulcer and to reverse the inflammation presentation in residual gastric mucosa. Methods Modified braun's operation was applied after partial gastrectomy in 23 cases of acute peptic ulcer with perforation with diffused perotonitis. Twenty two patients were followed up for 1～2 years. Among them, 19 cases were reexamined by gastroscopy and determined the choleglycine (CG) and helicobacter pylori (HP) of stomach. The empyte of residual stomach was examined with barium meal in 9 patients. Results All of the patients recovered well after the operation. According to visike's staging, the successful rate was 95.7%; the elimination rate of inflammation in residual stomach was 73.7%; HP found in 58% of patients before operation declined to 21% after operation. No bile regurgitation to residual stomach was seen in any patients after operation. On gastroscopy and barrium meal examination, only one patient had some delaying gastric empty owing to an efferent loop adhesion. Conclusions Modified Braun's operation could effectively eliminated the residual gastritis. So it is an important operation in preventing the occurrence of residual gastritis and residual gastric carcinoma .